To,

The Regional Provident Fund Commissioner,

Mumbai.

Sub: Application for regularizing membership/Provident Fund contribution

deducted on salaries over and above Rs.6500/-or higher rate.

Sir,

I the undersigned Mr. /Ms / Mrs. ------------------------------------------- bearing account no.

MH/------------------ employee of M/s. ----------------------------------------, Mumbai hereby
declare that I have been contributing Provident Fund on my basic salary at the rate of
12% with effect from -------------.

I am not an ‘excluded’ employee within the meaning of Para 2 (f) of the Employee’s
Provident Fund Scheme, 1952.

I request that:
 I may be enrolled as member of the Employee’s Provident Fund voluntarily with
effect from -----------------.
 I may be permitted to contribute voluntarily on my basic pay exceeding Rs.6500/- per
month with effect from -----------------.
 I may be permitted to contribute @ ----------- % instead of the statutory of 12% with
effect from --------------.

Yours faithfully,

Signature of the Employee

-----------------------------------------------------------------------------------------------------------
FOR OFFICE USE ONLY

We ----------------------------------------- bearing code no. MH/-------------- hereby declare

that:
1. We have voluntarily enrolled Mr./Mrs./Ms. --------------------------- as member
of the Employee’s Provident Fund with effect from -------------- and his/her
account no. is MH/---------.
2. We have been making contribution on basic pay exceeding Rs. 6500/- per
month with effect from ------------------.
3. We have been deducting Provident Fund Contribution voluntarily @ -------% of
pay and making contribution @ 12% on basic pay.
4. We have paid Administrative Charges and submitted all the returns in respect of
the above member accordingly and will continue to so.

We request that this case be regularized by permitting voluntary membership and

contribution on basic salary @ Rs. --------------- of pay as stated above.

Yours faithfully,
For -------------------------------

Authorised Signatory
PLACE: ------------------
DATE: -------------------