Name
Age
Father's name
Residential address
(a)
(b)
(c)
(d)
(i)
(ii)
(iii)
Signature of the Employer
Designation
Seal of the Establishment
Dated the ..................... 20...................
Note.-Any change in the information given above should be intimated, in writing, to the Regional Commissioner within fifteen days of such change by registered post and in the prescribed manner.
FORM 6 (Revised)
The Employees' Provident Funds Scheme, 1952
(Paragraph 43)
Return of the Contribution Cards sent to the Commissioner on the expiry of the period of currency from ..............to..................
Name and address of the factory/ establishment ....................................................................
Code No. of the factory/ establishment ....................................................................................
Sl. No.
Account No.
Name of the member (in block letters)
Employer's Total Contribution
Member's Total Contribution
Amount refunded
Remarks
E.P.F.
E.P.F. @ 11/6%Total
Rs.Rs.Rs.
E.P.F.
E.P.F. @ 11/6%Total
Rs.Rs.Rs.
1
2
3
4
5
6
7
Total number of cards sent.........................
Signature of the employer or other
Authorised Officer of factory/ establishment
Dated the ..................... 20...........................
Stamp of the factory/ establishment
FORM 6-A
(For Unexempted Establishments only)
The Employees' Provident Funds Scheme, 1952
[Paragraphs 30 and 38(3)]
The Employees' Pension Scheme, 1995
[Paragraph 20(3)]
Consolidated Annual Contribution Statement
Annual statement of contributions for the Currency period from 1st ........................... 20............................ to........................... 20........................... Name and address of the Establishment ..................................................................................Statutory rate of contribution...................................... Code No. of the Establishment ...................................................No. of members voluntarily contributing at a higher rate......................................
Sl. No.
Account No.
Name of the member (in block capitals)
Wages, Retaining allowance (if any) and D.A. including cash value of food concession paid during the currency period
Amount of worker's contributions deducted from the wages
Employer's Contribution
Refund of advance
Rate of higher voluntary contribution
(if any)
Remarks
EPF difference between 12% & 10%
Pension fund 10%
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Reconciliation Of Remittances
Sl. No.
Month
Amount remitted
Administration charges Rs. at 1.10% of wages
Aggregate Contributions Cols.
5+6+7 (Rs.)
EPF Contributions including refund of advances A/c No. 1
Pension Fund contributions A/c No. 10
EDLI contribution A/c No. 21
Admn. Charges A/c No. 2
EDLI Admn.
Charges 0.001%
Remarks
1
March paid in April
Rs.
Rs.
Rs.
2
April
Rs.
Rs.
Rs.
3
May
Rs.
Rs.
Rs.
4
June
Rs.
Rs.
Rs.
5
July
Rs.
Rs.
Rs.
6
Aug.
Rs.
Rs.
Rs.
7
Sept.
Rs.
Rs.
Rs.
8
Oct.
Rs.
Rs.
Rs.
9
Nov.
Rs.
Rs.
Rs.
10
Dec.
Rs.
Rs.
Rs.
11
Jan.
Rs.
Rs.
Rs.
12
Feb. paid in March
Rs.
Rs.
Rs.
13
Arrears if any
Rs.
Rs.
Rs.
Total
Rs.
Rs.
Rs.
(1)
Total number of contribution cards enclosed (Form 3-A Revised)
(2)
Certified that Form 3-A, duly completed, of all the members listed in this statement are enclosed, except those already sent during the course of the currency period for the final settlement of the concerned members account vide Remarks furnished against the names of the respective members above.
Signature of employer with official seal
Note.-(1) The names of all members, including those who had 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 against the members in the "Remarks " column above thus "Form 3-A already sent in the month of ............. 20...................
(2)
In case of substantial variation in the wages/contributions of any member as compared to those shown in previous statement, the reason should be explained adequately in the "Remarks " column.
(3)
In respect of those members who have not opted for Pension Fund their entire employers contribution @10% or 12% as the case may be shown under column No. 6.
[***] [Form 7 omitted by G.S.R. 449, dated 4.3.1968]
[***] [Form 8 omitted by G.S.R. 521, dated 16.8.1991 (w.e.f. 7.9.1991)]
FORM 9
Application For Review Filed Under Sub-Section (1) Of Section 7-B Of The Employees' Provident Funds And Miscellaneous Provisions Act, 1952
(Paragraph 79-A)
For use in Commissioner's Office
Date of filing or
Date of receipt by post
Registration No
Signature
for Commissioner
1. Name of the applicant
____________________________________________________________________
2. Designation of the applicant or his relationship with the factory/ establishment (whether owner/partner/director/manager, etc., to be indicated)
____________________________________________________________________
3. Name and complete address of the factory/ establishment
____________________________________________________________________
4. Address of the employer for service of notice/summons
____________________________________________________________________
5. Particulars of the order against which the review application is filed-
____________________________________________________________________
(i) Order No.
____________________________________________________________________
(ii) Date of order
____________________________________________________________________
(iii) Passed by
____________________________________________________________________
(iv) Subject in brief
____________________________________________________________________
6. Main ground(s) on which the application for review has been made and the relief(s) sought.
(If necessary, attach a duly signed statement with copies of the documents relied upon marked as A-1, A-2, A-3 and so on.)
____________________________________________________________________
Verification
I ........................(name of the applicant) S/o, D/o, W/o................age...............working as ..............resident of ...................do hereby verify that the contents of particulars given at Sl. Nos. 1 to 6 above are true to the best of my knowledge and belief and I have not suppressed any material fact. I further declare that :
(i) I am filing the application within 45 days from the date of the original order.
(ii) I have not preferred any appeal against the original order under the Employees' Provident Funds and Miscellaneous Provisions Act, 1952.
(iii) I am filing with this application, the original document authorising me to represent the aggrieved person (applicable only in cases where the application is filed by agent, advocate or other representative).