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  • Break Statement

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    Deepak Karamchandani
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    This document is a form for recording an employee's breaks in service from an organization. It requests the employee's name and address, account number, date of joining, and date of leaving. It then has tables to record the years, months, and days of any breaks in service, along with totals. The employer must sign with an official seal after filling in the totals.

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    This document is a form for recording an employee's breaks in service from an organization. It requests the employee's name and address, account number, date of joining, and date of leaving. It then has tables to record the years, months, and days of any breaks in service, along with totals. The employer must sign with an official seal after filling in the totals.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    3 views1 page

    Break Statement

    Uploaded by

    Deepak Karamchandani
    This document is a form for recording an employee's breaks in service from an organization. It requests the employee's name and address, account number, date of joining, and date of leaving. It then has tables to record the years, months, and days of any breaks in service, along with totals. The employer must sign with an official seal after filling in the totals.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    BREAK STATEMENT

    1 Name and address of the establishment :- ______________________________________________

    ______________________________________________

    2 Name of the Employee :- ______________________________________________

    3 Account No. of the Employee :- ______________________________________________

    4 Date of joining E.P.F./E.P.S. :- ______________________________________________

    5 Date of Leaving/Death :- ______________________________________________

    Sr. No. Year Total Breaks Sr. No. Year Total Breaks

    Y M D Y M D

    Total Total

    Y M D Y M D
    Total Service
    Total Brak in Service
    Total Reckonable Service
    *Breaks Only the absentee period for which wages have not been paid.

    Signature of the
    Employer with Official Seal

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