To:

The Regional provident Iund commissioner,

Sub Regional OIIice,
Ambattur,
Chennai.


Sir,

Sub: Extension of Employees` Provident Funds and Miscellaneous Provisions Act, 1952 under
the section 1(4) on voluntary basis - Consent and request for - Regarding


1. e__________________________________________________ the
proprietor/Director/partners of M/s.



Do here by apply coverage under section (1)4 oI the act Employees` Provident Funds and
Miscellaneous Pprovisions Act, 1952 on voluntary basis with eIIect Irom ....... the last date oI
the month in which the notiIication is published in the gazette oI India. I/We as employer(s), do hereby
under take to and will pay my /our share(s) oI Provident Fund and Pension Fund contributions at the
rate oI as provided as under sections 6 and 6A oI the said act read with paragraph 29 and 38 oI
Employees` Provident Funds scheme, 1952 and paragraphs 3 and 4 oI the Employees Pension Scheme,
1995 and administrative charges as provided under paragraphs 38 and 39 to the Employees` Provident
Fund Scheme and to abide by all provisions and requirements oI the said statue and the rules Iramed
there under as amended Irom time to time.


2. The majority oI the employees are willing to pay their shares oI contributions at the rate oI
.... and have agreed to comply with the provisions oI the Employees` Provident Funds and
Miscellaneous Provisions Act, 1952 and the schemes Iramed there under. The written consent
to this eIIect is enclosed.

3. I/We, as employer(s) do hereby undertake to and will pay the Employees Deposit Linked
Insurance scheme contribution at the rate oI 0.5 as provided under section 6c oI the said act
read with paragraph 7 oI the said scheme and administrative charges at the rate oI .01 as
provided under para 3 oI the said scheme and to abide by all provisions and requirements and
the statue and the rules Iramed there under Irom time to time.

4. I/We also under take and agree to extend the beneIits under the scheme Iramed under
Employees` Provident Funds and Miscellaneous Provisions Act, 1952 to the employees
employed in my/our other branches. OIIices
/units/department/Iactories,namely,........................
......... The majority oI the workers employed in the above mentioned concerns
have also subscribed to the 'consent by the majority oI total employees.

5. I/We, as employer(s), have no objection to the workers, contributing at the rate oI .... and
I/We, undertake to pay the necessary administrative charges as Iixed by the central government
Irom time to time under para 39 oI the Employees` Provident Funds and Miscellaneous
Provisions Act , 1952 and para 8 oI the Employees` Deposit Linked Lnsurance, 1976.

6. Necessary arrangements may kindly be made to issue the necessary notiIication by the central
government.




Yours FaithIully,


Signature