FORM - 9 (Revised)

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 [PARA 36(1)] AND THE EMPLOYEES' PENSION SCHEME, 1995 [PARA 20(1)]
RETURN OF EMPLYEES WHO ARE ENTITLED AND REQUIRED TO BECOME MEMBERS OF EMPLOYEES' PROVIDEND FUND AND PENSION FUND

Code No. TN/

Name & Addressof the
Factory / Establishment

Industry in which the Factory / Establishment is engaged Date of Coverage

Registration No. of the Factory / Establishment Date from which Employees' Pension Scheme is applicable

If Factory / Establishment is covered under E.S.I. Act inidicate the Code No. allotted under E.S.I. E.S.I. Code No.

If not, furnish the details of the designated Medical Officer of the Factory / Establishment Name of the Designated Medical Officer

SPECIMEN SIGNATURE OF THE EMPLOYER OR AUTHORISED OFFICAL

SL.NO. NAME DESIGNATION SPECIMEN SIGNATURE

Remarks, if any :

Signature of the Employer or other Authorised Officer

Date and stamp of Factory / Establishment
Notes : (1) This Form should be accompanied by declaration in Form 2 by every Employee.
(2) Any change in the Authorised Offical / Designated Medical Officer should be intimated to the Commissioner
 FORM - 9 (Revised)
No. of Employees enrolled as members on the sate of Coverage
RM - 9 (Revised)
52 [PARA 36(1)] AND THE EMPLOYEES' PENSION SCHEME, 1995 [PARA 20(1)]
RED TO BECOME MEMBERS OF EMPLOYEES' PROVIDEND FUND AND PENSION FUND

Date from which Employees' Pension Scheme is applicable

SPECIMEN SIGNATURE

Signature of the Employer or other Authorised Officer

Date and stamp of Factory / Establishment
 FORM - 9 (Revised)

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 [PARA 36(1)]

THE EMPLOYEES' PENSION SCHEME, 1995 [PARA 20(1)]

Registration No.

Name & Address of the

Factory / Establishment }
 TOPNOTCH INFOTRONIX INDIA PVT. LTD Page 5
No.6, Valliamal Road,

CODE.NO:TN/52532/
Vepery, FORM NO.9 (Revised)
Chennai - 600 007
Remarks & Initials on settlement
Sl.N PF A/c Emp ID Father Name (or) Husband Date of Date of Date of Date of Date of
Name of the Employee Sex EPF / EPS / DLI
o No No Name Birth Joining Leaving Re-Joining Leaving
DC SS AAO AC