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FORM NO. 10 The Employee's Provident Fund Scheme, 1952 [Paragraph 36(2)(A) &(B)] Employee,s Pension Scheme,1995[paragraph 20(2)] Return of the members leaving service during the month of January 2008 SL NO. Father's Name (or Name of member ( In block husband's name in case of Account No letters) married woman) 1 2 3 4 1 2 3 4 5 Place: Date:
Stamp of establishment Please state whether the member is (a) retiring according to para 69(1) (a) (b) of the scheme (b) leaving India for permane retrenchment(d)ordinarily dismissed for serious an willful misconduct (e) discharge(f)resigning from or leaving service(g)ta elsewhere. (The name and address of the employers should be stated)(h) Death.
A request for deduction from the account of the member dismissed for serious and willful misconduct should be reserted by the followin
"Certified that the member mentioned at seriol No._____ Shri _____________ was dismissed for serious and willful miscon that the Employer's contribution for ____________ should be forfeited from the account in the fund. A copy of the order of d is enclosed." "Certified that the member mentioned at seriol No._____ Shri _____________ was paid/not paid retrenchment compensati under the Industrial Dispute Act 1947." Also fill in form no. 5 overleaf
CODE NO OF FACTORY/ESTABLISHMENT:
Remarks 7
Authorized Signatory the scheme (b) leaving India for permanent settlement abroad rge(f)resigning from or leaving service(g)taking up employment
misconduct should be reserted by the following certificate
as dismissed for serious and willful misconduct. I recommend ccount in the fund. A copy of the order of dismissed
Authorized Signatory
FORM 12-A (REVISED) (To be filled by the EPFO EMPLOYEES' PROVIDENT FUND AND MISC PROVISIONS ACT 1952 Employees' Pension Scheme (Paragraph 20(4)} Name and address of the Establishment
CURRENCY PERIOD FROM IST APRIL 2007 TO 31ST MARCH-2008
Statement of contribution for the month of Statutory rate of contribution for the month of
CODE NO
Particulars Wages on which contributions are payable the workers Amount of Contribtion 3 Recovered from Payable by the employer Worker's share Amount of Contribution remitted 4 Employer's Share Amount of adminitrative charges due
Nil
Nil
Nil
E.D.L.I. A/C NO.21&22 Nil Total No of Employees (a)Contract (b)Rest (c) Total 0 Details of Subscribers No.of Subscribers as perlast month No.of New Subscribers (Vide Form5) No.of Subscribers left service (Vide Form 10) (Nett) Total Number of Subscribers
Nil Name & Address of the Bank in which the amount is remitted E.P.F. Pension Fund 0 0 0 0 0
EDLI 0 0 0 0
Nil
Sr. No.
1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
0.00
0.00
0.00
0.00
NOTE:- (1) The names of all members, including those who had left service during the currency period, should be included in th (2) In case of substantial variation in the wages/contribution of any members as compared to those shown in previous months s (3) In respect of those members who have not opted for Pension Fund entire employers contribution @ 81/3 % or 10% as the c
Form - 6A
cheme, 1995
rate of contribution
Total
Refund of Advance
Remarks
(if any) 7 8 9 10
0.00
0.00
od, should be included in this statement. Where the Form3-A in respect of such members had left service, the fact should be stated against shown in previous months statement. The reason should be explained adequately in the 'Remarks' column. n @ 81/3 % or 10% as the case may be shown under column No.6.
FORM NO. 5
( The Employee's Provident Funds Scheme,1952[ Paragraph 36(2) (A) ] & The Employees' Pension Scheme,1995 [Paragraph 20 (4) ] )
CODE NO O
Details of Employees qualifyind for membership of the fund for the first time during the month of January 2008 (To be sent to the commissioner with form 2(EPF & EPS)
S.No Account No 1 2 1 2 3 4 5 6 7
Date of Birth 5
CODE NO OF FACTORY/ESTABLISHMENT :
Sex 6
Total period of previous service as on the date of joining the fund (Enclose scheme certificate if applicable) Remarks 8 9
Authorised Signatory