Get documents about "Form 12a 5 10 242133437
Document Sample
Name and address of the Factory / Establishment
FORM NO.10
[See Paragraph 36(2)(a) & (b) of the Employees'
Provident Funds Scheme, 1952]
[See Paragraph 20(2) of the Employees' Pension
Scheme 1995]
Code No. of the Factory / Establishment TN
RETURN OF MEMBERS LEAVING SERVICE DURING THE MONTH OF__________
Sl. Name of the Employee (IN Father's Name (or Husband's Name) Date of Leaving Reasons for
Account No. Remarks
No. BLOCK CAPITALS) in case of maried woman) Service Leaving Service
(1) (2) (3) (4) (5) (6) (7)
Stamp of the Factory / Establishment Signature of the Employer or other Authorised Officer
of the Factory / Establishment
(Only for Un-Exempted Establishments)
Name and Address of the Establishment
FORM 12 - A (REVISED) (To be filled by the EPFO)
M/s. EMPLOYEES' PROVIDENT FUND AND MISC. PROVISIONS ACT, 1952 EMPLOYEES'
PENSION SCHEME [PARAGRAPH 20(4)]
Establishment Status
Currency Period from 1st April 20 to 31st March 20
Statutory rate of contributions for the Month of Group Code :
CODE NO: TN/ Statutory rate of contribution 12%
Particulars Wages on Amount of Contibution Amount of Contribution Amount of Amount of Date of
(1) which (3) remitted Administrative Administrative Remittance
contribution are (4) charges due charges (enclosed
payable (5) remitted triplicate
(2) Recovered Payable Worker's Employer's (6) copies of
from the by the Share Share challan)
workers employer
E.P.F. A/c No.01
Pension Fund A/c No.10 NIL NIL NIL NIL
D.L.I. A/c No.21 NIL NIL
Total No of Employees
(a) Contract Name and address of the STATE BANK OF INDIA
(b) Rest Bank in which the amount
(c) TOTAL is remitted Rs.
Details of Subscribers EPF Pension Fund EDLI
No. of subscribers as per last month
No. of New subscribers [Vide Form 5]
No. of Subscribers left service [vide Form 10] Authorised Signatory
[Net] Total Number of Subscribers Signature of Employer with Official Seal.
FORM NO.5
THE EMPLOYEE'S PROVIDENT FUND SCHEME ,1952 AND THE EMPLOYEE'S PENSION SCHEME,1995
[Paragraph 36 (2) (a)] (b) [Paragraph 20(2) (4)]
Name and address of the Factory / Establishment :
Month…………………………………
Code No. of the Factory / Establishment TN / /
Return of Employees qualifying for membership of the Employees' Provident Fund ,Employees' Pension Fund & Employees' Deposit Linked Insurance Fund for the first Time during the month
(To be sent to the Commissioner with From.2) (EPF and EPS)
Sl. Name of the Employee (IN Father's Name (or Husband's Name) Date of Joining the
Account No. Date of Birth Sex Remarks
No. BLOCK CAPITALS) in case of married woman) Fund
(1) (2) (3) (4) (5) (6) (7) (8)
Indicate the following in the remarks:-
1) Previous A/c no & service particulars - with Form-13 (Revised) 2) The Scheme Certificate control No., if any, enclosing the certificate 3) Details' of Pension being drawn,if any under EPS..95 (Such member should be enrolled
for PF fund & EDLI only) 4)Enclose Form - 2 ( Revised),giving nomination for PF & also for Pension by all members5) An employee who has attained the age of 58 will not be eligible to become a member of EPS.95 only.
Return of the members leaving service during the month…………………………… FORM NO.10
Sl. Name of the Employee (IN Father's Name (or Husband's Name) Reasons for Leaving
Account No. Date of Leaving Service Remarks
No. BLOCK CAPITALS) in case of married woman) Service
(1) (2) (3) (4) (5) (6) (7)
Please state whether the member is (a) retiring according to para 69(1) or (b) of the scheme:(b) leaving India for permanent settlement abroad:(c ) reterenchment :(d) discharged:(e) resigning from or leaving service:taking up
employment elsewhere(The Name&address of the Employers should be stated):(g) Date of Death.A member.on attaining the age of 58,is ceased to be a member of EPS -95,Subject to eligibilty he may apply for drawal of Pension.
Signature of the Employer or other Authorised Officer
Date……………….. of the Factory / Establishment
Name and address of the Factory / Establishment
FORM NO.5
[See Paragraph 36(2)(a) of the Employees' Provident
Funds Scheme, 1952]
[See Paragraph 20(4) of the Employees' Pension
Scheme 1995]
Code No. of the Factory / Establishment TN
RETURN OF EMPLOYEES QUALIFYING FOR MEMBERSHIP OF THE EMPLOYEES' PROVIDENT FUND, EMPLOYEES' PENSION FUND AND EMPLOYEES' DEPOSIT LINKED INSURANCE
FUND FOR THE FIRST TIME DURING THE MONTH OF __________________ (To be sent to the Commissioner with Form No.2) (EPF and EPS)
Total period of
previous service as
Date of on the date of
Sl. Name of the Employee (IN Father's Name (or Husband's Name)
Account No. Date of Birth Sex Joining the joining the Fund Remarks
No. BLOCK CAPITALS) in case of maried woman)
Fund (Enclose Scheme
Certificate if
applicable)
(1) (2) (3) (4) (5) (6) (7) (8) (9)
Stamp of the Factory / Establishment Signature of the Employer or other Authorised Officer
of the Factory / Establishment
