Statutory Compliance Verification and Bill Clearance Form for Contracts Date: To: The Accounts Officer/BHEL/BAP/Ranipet Sir. Sub: Request for clearance of bill (s) for the month of, 20__ Ref: Contract No.. ‘Nature of Contract, Period of Contract from to. - No. of Workers. Bill No., dated. for Rs. ‘The bills (s) as per the details given below are pending to be released by Accounts Department. I have completed the necessary statutory obligations as per details given below: PF paid for the month of in PF Code No. ESI* paid for the month of in ESI Code. No, at STATE BANK OF INDIA, Code No. of Bank, ‘Address ofthe Banke toninnn 2 aeteiee ee OR On line payment made for ESI & PF. SL. AMOUNT NO. DESCRIPTION PAID @S) REMARKS o1 ‘AIG. No.l_{12%) Employees share 2 AIC. No.l _43.67%)Employers share o AIC. No.2 (1.10%)Admn. charges 4 AC. No.10 (8.33%)Employers share PENSION iy AC. No.2! (0.50%) EDLI 06 ‘AIC, No22 (0.01%) EDLT ADMN.CHARGES 07 EST (4.75%) Employers share 8 EST (1.75%) Employees share TOTAL Our site is not declared as ESI covered area. Hence our contract workers are covered by comprehensive accident insurance. © Original PF & ESI challans to be shown to Welfare, after verification it will be returned. One set xerox copies of all relevant documents like attendance/ wages registers and clectronically generated PF & ESI challans along with the name list of beneficiaries are enclosed herewith. Kindly release the payment for the month of, : ‘Yours Sincerely, Signature & Seal of the contractor with date.