ABC COMPANY LIMITED Feb-09

S.No. 1 2 3 4 5 6 7 8 9 10 11 12 13 PF No. AP/48131/001 AP/48131/002 AP/48131/003 AP/48131/004 AP/48131/005 AP/48131/006 AP/48131/007 AP/48131/008 AP/48131/009 AP/48131/010 AP/48131/011 AP/48131/012 AP/48131/013 A B C D E F G H I J K L M Employee Name Basic 32,340 0 16,800 13,814 11,592 9,008 8,960 8,680 6,340 6,684 5,871 6,076 6,207 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Employee Share 12% 3,881 0 2,016 1,658 1,391 1,081 1,075 1,042 761 802 705 729 745 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Employer Share 8.33% (limit is 6500) 541 0 541 541 541 541 541 541 528 541 489 506 517 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3.67% 3,340 0 1,475 1,117 850 540 534 501 233 261 216 223 228 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Basic more than Rs.6500/25,840 0 10,300 7,314 5,092 2,508 2,460 2,180 0 184 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Total

1,32,372 76,494
A/c No.1 9,518 15,886

15,886
A/c No.2

6,368
A/c No.10 6,368

9,518
A/c No.21 382

55,878
A/c No.22

Employer's Share of Contribution Employees's Share of Contribution Administration Charges Penal Damages Total NOTES : I. You need to chande the following details in all forms 1

1,456

25,404

1,456

6,368

382

Enter employee account no, name and basic

change need single monthly single single yearly monthly single monthly monthly monthly monthly

2 Month of Contributions 3 Company's PF code 4 Company's Address 5 Currency period 6 total no of subscribers during the month 7 Name of the Depositor 8 bank and cheque detials 9 date of remittence 10 Bank address New joined employees with account nos and 11 the detials required in form 5

Relived employees with account nos and the 12 detials required in form 10

monthly

Total

16,268 15,886 1,464 0 33,618

COMBINED CHALLAN OF A/C No. 1,2,10,21 & 22

Original / Duplicate / Triplicate / Quadruplicate

STATE BANK OF INDIA

EMPLOYEE'S PROVIDENT FUND ORGANISATION

(USE SEPARATE CHALLAN FOR EACH MONTH)

ESTABLISHMENT CODE NO.

AP/48131
Employees Share Employer Share

ACCOUNT GROUP NO Month Year 02 02 90 2009 2009 DATE OF PAYMENT 90 A/c 10 1,32,372 76,494 A/C No 2. . A/C No. 10
Amount

PAID BY CHEQUE/CASH D 12 D M 02 M Y

CHEQUE Y 2009 90

DUES FOR THE MONTH OF:

TOTAL NO. OF SUBSCRIBERS A/c 1 TOTAL WAGES DUE SL. No PART - 01 1 EMPLOYER'S SHARE OF CONT. 2 EMPLOYEE'S SHARE OF CONT. 3 ADM. CHARGES 4 INSP. CHARGES 5 PENAL DAMAGES 6 MISC. PAYMENT (PAST ACCUMULATIONS ONLY) TOTAL 25,404 9,518 15,886 PARTICULARS A/C No. 1

A/c 21 76,494 A/C No.22 TOTAL A/C No. 21

(In Rupees) .

6,368

382

16,268 15,886

1,456

1,464

1,456

6,368

382

33,618

(AMOUNT IN WORDS) Thirty Three Thousand Six Hundred and Eighteen Only [FOR BANK'S USE ONLY] NAME OF ESTABLISHMENT: ADDRESS: ABC COMPANY LIMITED AMOUNT RECEIVED Rs. FOR CHEQUES ONLY DATE OF PRESENTATION DATE OF REALISATION NAME OF DEPOSITOR DHARAMA RAO BRANCH NAME BRANCH CODE NO SIGNATURE OF THE DEPOSITOR (TO BE FILLED IN BY EMPLOYER) NAME OF THE BANK ICICI BANKK CHEQUE NO 410389 DATE 03.03.2009

HI-TEC CITY,HYDERAVAD

Only for un-exempted establishment

FORM 12-A (REVISED)

EMPLOYEES' PROVIDENT FUND AND MISC PROVISIONS ACT 1952 EMPLOYEES' PENSION SCHEME [Paragraph 20(4)]

Name and address of the Establishment ABC COMPANY LIMITED HI-TEC CITY Statement of contribution for the month of Hyderabad - 500 033 Statutory rate of contribution Feb-09 12% Currency Period from 1st March'2008 to 28 Feb'2009 Establishment status Group Code

(To be filled by the EPFO)

CODE NO: AP/48131

Particulars Wages on which contributions are payable 2 Amount of Contribtion Recovered from the workers 3 Payable by the Employer

Amount of Contribution remitted Worker's share Employer's Share 4

Amount of administrative charges due 5

Amount of Date of remittence administrative (Enclose triplicate copeis of charges remitted Challan) 6 7

E.P.F. A/C NO. 01 PENSION FUND A/C NO. 10 E.D.L.I. A/C NO. 21 Total No of Employees (a)Contract (b)Rest (c) Total

1,32,372 76,494 76,494

15,886 NIL NIL 90 0 0 90

9,518 6,368 382

15,886 NIL NIL

9,518 6,368 382

1,456 NIL 8

1,456 NIL 8

1 1 1

2 2 2

0 0 0

2 2 2

2 2 2

0 0 0

0 0 0

Name and address of the bank in which amount is remitted

State Bank of India, Hi-Tec City Branch, Cyber Towers, Madhapur, Hyderabad - 33

Details of Subscribers No.of Subscribers as per last month No.of New Subscribers (Vide Form5) No.of Subscribers left service (Vide Form 10) Total Number of Subscribers (Net)

E.P.F. 90 0 0 90

Pension Fund 90 0 0 90

EDLI 90 0 0 90 Signature of employer with official(Seal)

UND AND MISC PROVISIONS ACT 1952

(To be filled by the EPFO)

Date of remittence (Enclose triplicate copeis of Challan) 7

9 9 9

State Bank of India, Hi-Tec City Branch, Cyber Towers, Madhapur, Hyderabad - 33

Signature of employer

The Employees' Provident Fund Scheme, 1952

Paragarph 36 (2) (a) and (b)

Form - 10

Employees' Pension Scheme, 1995

Paragarph 20 (2) Return of Members leaving service during the month of : Name & Address of the Factory/ Establishment : Code No. of Factory/ Establishment :

Feb-09
ABC COMPANY LIMITED HI-TEC City, Hyderabad.

AP/48131
Name of the parent ( or name of the spouse if married)

S. No

Account No.

Name of the Member (in BLOCK letters)

Date of Leaving Service

Reason for Leaving Service

Remarks

1 2 3 4 5 6 7 8 9 10 11 12

The Employees' Provident Fund Scheme, 1952

Paragarph 36 (2) (a) and (b)

Form - 5

Employees' Pension Scheme, 1995

Paragarph 20 (4) Return of Employees' qualifying for membership of the Employees' Provident Fund, Employees' Pension Fund & Employees' Deposit Linked Insurance fund for the first time during the month of To be sent to the Commissioner with Form 2 (EPS & EPF) Name & Address of the Factory/ Establishment : Code No. of Factory/ Establishment : ABC COMPANY LIMITED,HI-TEC CITY Hyderabad - 500 033

Feb-09

AP/48131
Total Period of Previous Service Date of as on the date of Joining the joining the Fund (Enclose scheme Fund certificate if applicable)

S. No

Account No.

Name of the Member (in BLOCK letters)

Name of the parent ( or name of the spouse if married)

Date of Birth

Sex

Remarks

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Date :

8/17/2011

Signature of the employer or other authorised officer and stamp of the Factory /Establishment