THE EMPLOYEE'S PROVIDENT FUND SCHEME, 1952

(Paragraph (36) 2 (a))

FORM NO. 5

Return of employees qualifying for membership of employee's prvident Fund & Family Pension Fund and EDLI Scheme 1976 for the first time during the Month August 2010 (To be sent to the Commissioner, Gujarat State with both E.P.F. & F.P.F. Forms No.2) Name & Address for the Factory / Establishment: SHREE JAGANATH ENTERPRISES Sr. No. 1 Name of the Employees (In block letter) 3 Father's Name (or husband's name in the case of married women) 4
Code No : GJ/SRT/38045

Account No. 2

Age 5

Sex 6

Date of eligibility for membership 7

Total period of previous Services (excluding periods of breaks as on the date of joining the fund) 8

Remarks 9

Signature of Employer or authorised officer, of the Factory/Estt. Date: Also Fill in form No. 10 Overleaf Stamp of the Factory / Estt.

THE EMPLOYEE'S PROVIDENT FUND SCHEME, 1952

(Paragraph (36) 2 (a) & (b) )
FORM NO. 10 Return of members leaving Service during the month of : July 2010 Name & Address for the Factory / Establishment : Vinod Kumar Singh Sr. No. 1
1 2

Code No : GJ/SRT/31813

Account No. 2
2

Name of the Employees (In block letter) 3

Vinod Kumar Singh Jamil Aktar

Father's Name (or husband's name in the case of married Date of leaving Service women) 4 5
1/7/2010 1/7/2010

Reason of leaving Service 6

Left Left

Remarks 7

Signature of Employer or other authorised officer, of the Factory / Estt. Date: Stamp of the Factory / Estt. Note* : Please state whether the member is (a) retiring according to Para (69) (1) (a), or (69) (1) (b) leaving India for permanent abroad retrenchment (d) ordinarily dismissed for serious and willful misconduct(e) dischaarged (f) resigning from or leaving service (g) taking up employment elsewhere (the name and address of the Employer should be stated) Certified that the member mentioned at serial No. ____________________________________________ Shri ______________________________________________ was paid / not paid retrenchment compensation of Rs. ________________________________________ under the Industrial dispute Act, 1947 Also Fill in form No. 5 Overleaf

Only for Un-Exempted establishment Name and Address of the Estt. M/s SHREE JAGANATH ENTERPRISE

FORM 12-A (Revised)

EMPLOYEE'S PROVIDENT FUND AND MISC. PROVISION ACT, 1952 EMPLOYEE'S PENSION SCHEME - 1995 [(PARAGRAPH 20 (4))]
Currency period 1st April 2010 to 31st March, 2011 Statement of contributions for the Month of :- AUGUSAT-2010 Statutory rate of contribution : 12%

(To be filled in by the EPFO) Establishment Status Group Code ___________

Code No. GJ/SRT/38045 Wages on which Contributions are payable 2

227054

Particulars 1 E.P.F. A/c. No. 01

Amount of contribution 3 Recovered from Payable by the the workers employer

27246 8333

Amount of contribution remitted 4 Worker's Share Employer's Share

Amount of Administrativ e charge due 5

2498

Amount of Administrative charge remitted 6

2498

Date of Remittance (enclose triplicate copies of Challan)

27246

8333

Pension Fund A/c. No. 10

227054

18914

18914

D.L.I. A/c. No. 21

227054

1135

1135

23

23

Total No. of Employees (a) Contract (b) Rest (c) Total

62 62

Name & address of the ________________________________ Bank in which the Amount E. P. F. Pension Fund
________________________________ ________________________________

Details of Subscribers Nos. of subscribers as per last month No. of New Subscribers (Vide Form 5) No. of subscribers left services (Vide Form 10) Net. Total Numbers of Subscribers

E.D.L.I

Signature of the Employer with official Seal

Form 3 A
THE EMPLOYEE'S PROVIDENT FUNDS SCHEME 1952 (Para 35 and 42) AND THE EMPLOYEE'S PENSION SCHEME 1995 (Para 19) CONTRIBUTION CARD FOR THE CURRENCY PERIOD FROM

Account No. :

CONTRIBUTION
Worker's Share MONTH Amount of Wages 2 EPF 3 Employer's Shares EPF Diff. Btn. 10 & 8.33 4a P.F. Contri. 8.33 % 4b Refund of Advance 5 No. of days/Period of non-cont. service 6

1
Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Total

Certified that the difference between the total of contribution shown under Cols. No. 4 and 4a & 4b of the above table and that arrived at on the total wages shown in col No. 2 at the prescribed rate is solely due to the rounding off contribution to the nearest Rupee under the rules.

Form 6A (Revised)
The Employee's Provident Funds Scheme 1952 (Paragraph-43) and The Employee's Pension Scheme 1995 [Paragraph 20(4)] The Employee's Deposit Linked Insurance Scheme 1970 section 6 ( c ) STATEMENT OF CONTRIBUTION FROM MARCH 2009 TO FEBRUARY 2010 Name & Address of the Establishment: Code No. of Establishment: EMPLOYEE CONTRIBUTION E.P.F BASIC 12 % EMPLOYER CONTRIBUTION CONTRIBUTION EMPLOYER F.P.F E.P.F.

CODE

NAME OF THE EMPLOYEE

(STATE BANK OF INDIA)

EMPLOYEES PROVIDENT FUND ORGANISATION (USE SEPARATE CHALLAN FOR EACH MONTH) Establishment Code No. : GJ/SRT/37099 Dues for the month of:Aug-2010 Total no. of Suscriber: 225 Employees share Employers share Total Wages due: 948718 Sr.no. Particulars A/C NO.1 A/C NO.2 A/C NO.10 A/C NO.21 A/C NO.22 TOTAL Account Group No. _______________ M M Y Y
8 8 10 10

Paid by cash/Cheque/DD_____________ Date of payment:____________________

PART-01 AMOUNT ( In rupees) ___________________________________________________________ ___________________________________________________________________________________________________________

1 EMPLOYERS SHARE OF CONT 2 EMPLOYEES SHARE OF CONT 3 ADMN. CHARGES 4 INSP.CHARGES 5 PENAL DAMAGES 6 MISC.PAYMENT 34816 113847 10436 95 79039 4744 118599 113847 10531

TOTAL (Amount in words) :

148663

10436

79039

4744

95

242977

Two Lakh Forty Two Thousand Nine Hundrad Seventy Seven Only

(For banks use only) Amount received Rs.__________ For cheques/DD only__________ Date of presentation___________ Branch Name________________ Branch code no.______________

Name of Establishment : S.B Industrial Services Addres:Sign. Of the Depositor

To be filled in by the employer Name of the Bank__________________________Cheque no./ DD No.________________Date_____________________ ________________Date______________

______________________________________________________________________________________________________________

FOR USE IN RESPECT OF PAST ACCUMULATION ONLY A/CNO.1 A/C NO.2 A/C NO.10 A/C NO.21 PART-02__________________________________________________________________________________________________________ AMOUNT( in Rupees)_______________________________________________________________________________ 1 EER'S SHARE OF PAST ACCUM 2 ES'S SHARE OF PAST ACCUM 3 INT. NO. SECURITIES TOTAL

A/C NO.22

TOTAL