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Form 6A

THE EMPLOYEES PROVIDENT FUND SCHEME,1952


(Paragraph 43)

AND

THE EMPLOYEES' PENSION SCHEME,1995

(Paragraph 20-(4))
2008
Annual statement of contribution for the currency period from April 1st ................
2009
to March 31st...................................................................................................
Cybrosys Techno Solutions,
Name & Address of the Establishment...............................................................
Kinfra Neo Space,MalappuramPIN :6789089
.......................................................................................................................
NE/AGT/0003455/123
Code No.of the Establishment...........................................................................

S
l
n
o

Acco
unt
No.

(`1)
(2)
1 5

Name of
members(in
BLOCK
LETTERS)
(3)
SAMEENA

Wages,
retaining
allowance if
any and D.A.
including
cash value of
food concession
paid during the
currency
period
(4)
6500.00

12.00
Statutory rate of contribution..............
No. of members voluntarily contributing at a
0
higher rate.......................................

Amount of
workers
contribution
deducted
EPF Cont. (-)
from their
Pension
wages
Fund Cont.

Pension
Fund
@ 8.33%

Refund of
advances

(5)
780.00

(6)
239.00

(7)
541.00

(8)
0.00

(9)
0.00

Voluntary
contribution
Remarks
at higher
rate (if any)

SHAHID

65000.00

7800.00

2390.00

5410.00

0.00

0.00

KRISHNAN

93000.00

11160.00

4668.00

6492.00

0.00

0.00

10

ROUFAL.P

71000.00

9230.00

2390.00

5410.00

0.00

0.00

(10)

(1)

(3)

(2)

(4)

(5)

(6)

(7)

28,970.00 Rs.

Total Rs.

RECONCILIATION OF REMITTANCES

(8)

9,687.00

(9)

(10)

Rs.

17,853.00

Sl .No Month Amount remitted


Adm.charges Rs.
Contributions
Including refund
of advances
A/c No.1

Pension fund
contributions
A/c No.10

Adm.charges A/c
No.2

Rs

1,019

Rs

541

Rs

84

Rs

1,379

Rs

541

Rs

103

Rs

3,677

Rs

1,623

Rs

289

Rs

3,677

Rs

1,623

Rs

289

Rs

3,482

Rs

1,623

Rs

269

Rs

3,482

Rs

1,623

Rs

269

Rs

3,122

Rs

1,623

Rs

251

Rs

3,482

Rs

1,623

Rs

269

Rs

3,482

Rs

1,623

Rs

269

10

Rs

3,677

Rs

1,623

Rs

289

11

Rs

3,677

Rs

1,623

Rs

289

12

Rs

4,501

Rs

2,164

Rs

353

TOTAL

Rs

38,657.00 Rs

17,853.00

Rs

3,023.00

Aggregate of
Contributions

[
[

]
]

Cols 5,6,7,Rs.

1,

Total number of contribution cards enclosed


(Form 3A revised)

2,

Certfied that Form 3A duly completed of


all the memberes listed in this statement
are enclosed, except those already sent
during the course of the currency period
for the final settlement concerned
member's account vide 'Remarks'
furnishrd aganist the names of the
respective members above

Signature of employer
(with office seal)

Note:1. The name of all members,including those who have left service during the currency period should be included in this
statement.Where the form 3-A in respect of such members who had left service were already sent to the Regional
Office for the purpose of final settlement of their accounts,the fact should be stated aganist the names of said members
in the 'Remarks' column above,thus 'Form 3-A' already sent in the month of ............200
2.

In case of substantial variation in the wages/contributions of any members as compared tothose shown in previous
year's statement,the reason should be explained adequately in the 'Remarks' column.

3.

In respect of those who are not members of the Pension fund their entire employer's contribution @12% or 10% as the
case may be shown under column No.6