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					                                                       The Employees' Provident Fund Scheme, 1952                                                           Form - 5
                                                                      Paragarph 36 (2) (a) and (b)
                                                              Employees' Pension Scheme, 1995
                                                                           Paragarph 20 (4)

Return of Employees' qualifying for membership of the Employees' Provident Fund, Employees' Pension Scheme & Employees' Deposit Linked Insurance Fund for the first
time during the month of

To be sent to the Commissioner with Form 2

Name & Address of the Factory/ Establishment :
Code No. of Factory/ Establishment :

                                                                                                                                  Total Period of
                                                                                                                   Date of       Previous Service
                           Name of the Member            Father's Name or Husband's   Age/ Date of                              (excluding period
S. No Account No.                                                                                         Sex     Eligibility                           Remarks
                            (in BLOCK letters)          Name in case of married women    Birth                                   of breaks) as on
                                                                                                                 for Service
                                                                                                                                the date of joining
                                                                                                                                     the Fund
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 10
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 12
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 15



                                                                  Signature of the employer or other authorised officer and stamp of the Factory / Establishment

Note: Please furnish details of the membership in remarks column if the employee was a member of Employees' Provident Fund and Employees' Family Pension scheme
      before joining yourself/ factory. i.e. Account No. and/ or the name and particulars of the last employer.
                                                              The Employees' Provident Fund Scheme, 1952                                                             Form - 10
                                                                              Paragarph 36 (2) (a) and (b)
                                                                      Employees' Pension Scheme, 1995
                                                                                     Paragarph 20 (4)

Return of Members leaving service during the month of :
Name & Address of the Factory/ Establishment :
Code No. of Factory/ Establishment :



                              Name of the Member                Father's Name or Husband's              Date of Leaving
S. No Account No.                                                                                                           Reason for Leaving Service           Remarks
                               (in BLOCK letters)              Name in case of married women                Service


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 12



                                                                        Signature of the employer or other authorised officer and stamp of the Factory / Establishment
Please state whether the member is (a) retiring according to para 69 (1) (a) or (b) of the scheme; (b) leaving India for permanent settlement abroad; (c) retrenched; (d)
ordinarily dismissed for serious and willful misconduct; (e) discharged; (f) resigning from or leaving service; (g) taking up employment elsewhere (the name and address of the
new employer should be stated) ; (h) dead.

(1) A request for deduction from the account of a member dismissed for serious and willful misconduct should be reported by the following “certified that the member
mentioned at Sr. No.                 Shri.                                 was dismissed from the service for willful misconduct. I recommend that the employer's
contribution for                     should be forfeited from his account in the fund. A copy of order of dismissal is enclosed.

(2) In case of discharge from service, the following certificate should be filled.
Certified that the member mentioned in Sr. No.                       Shri.                                       was paid/ unpaid retrenchment compensation of Rs.
under the Industrial Disputes Act, 1947
                                                                           FORM 12-A (REVISED)

                                          THE EMPLOYEES' PROVIDENT FUNDS & MISC. PROVISION ACT, 1952
                                                EMPLOYEES' PENSION SCHEME [PRARGRAPH 20(4)]
Only for Un-Exempted Establishments
Name and address of the Establishment                                                                                                            (To be filled in by EPFO)

                                                   Currency period from 1st April                  to 31st March                             Establishment Status

                                                         Statement of Contributions for the month of

 Code No.                                                         Statutory Rate of Contribution          %                                  Group Code

             Particulars              Wages on which                                     Amount of Contributions      Amount       Amount                Date of
                                                          Amount of Contribution
                                       Contributions                                            Remitted                 of           of               Remittace
                                        are Payable                3                                4                  Admin        Admin           (Enclose Triplicate
                                                         Recovered Payable by the        Worker's     Employer's      Charges      Charges          Copies of Challan)
                                                          from the   Employer             Share         Share           Due          Due
                                                           Worker
                   1                        2                                                                             5           6
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                                                                    Name and address
(a) Contract                                                                             of the Bank in which
(b) Rest                                                                                  amount is remitted:
(c) Total

                                                       Pension
        Details of Subscribers            E.P.F.                    E.D.L.I.
                                                       Scheme
Number as per last month's
return
+) Number of Subscribers vide
Form No. 5
-) Number of Subscribers vide
Form No. 10
Net total                                                                                               Signature of Employer with Office Seal
                                                        COMBINED CHALLAN - A/C. NO. 1, 2, 10, 21 & 22                                                        ORIGINAL
                                                                                                                                                             DUPLICATE
                                                    EMPLOYER'S PROVIDENT FUND ORGANIZATION                                                                   TRIPLICATE
                                                            (USE SEPARATE CHALLANS FOR EACH MONTH)                                                           QUADRUPICATE


ESTABLISHMENT CODE NO.: UP\48043                    ACCOUNT GROUP NO.:                                                PAID BY CHEQUE/ CASH

                                                                        M         M    Y     Y      Y   Y
DUES FOR THE MONTH                                       Employee Share 1         0    2     0      1   0                                 D      D   M   M   Y   Y    Y     Y
OF :                                                                                                                DATE OF PAYMENT
                                                         Employer Share      1    0    2     0      1   0

Total No. of Subscribers:                                              12455.00                                    28269.00                                      1697.00
                                                A/c 1                                      A/c 10                                       A/c 21
Total Wages Due:                                                       40724.00                                        0.00                                          0.00

                                                    A/C NO. 1             A/C NO. 2           A/C NO. 10       A/C NO. 21            A/C NO. 22              TOTAL
S. NO.                PARTICULARS
                                                                                                 AMOUNT (in Rupees)

   1     EMPLOYER'S SHARE OF CONTRIBUTION                 12455.00                                      28269.00        1697.00                                  42421.00

   2     EMPLOYEE'S SHARE OF CONTRIBUTION                 40724.00                                          0.00                                                 40724.00

   3     ADMINISTRATIVE CHARGES                                              3733.00                                                       35.00                  3768.00

   4     INSPECTION CHARGES                                                                                                                   0.00                      0.00

   5     PENAL DAMAGES                                          0.00                                        0.00              0.00            0.00                      0.00

   6     MISCELLANEOUS PAYMENT                                                                                                                0.00                      0.00

                                      TOTAL               53179.00           3733.00                    28269.00        1697.00            35.00                 86913.00

                                                (Amount in words Rupees EIGHTY SIX THOUSAND NINE HUNDRED & THIRTEEN Only                       Only)
                        Gallantt Ispat Limited.
NAME OF THE ESTABLISHMENT                                                             (For Bank use Only)
ADDRESS                 AL-5, Sector 23, GIDA, Sahjanwa, Gorakhpur                    Amount Received Rs. 86913.00
                                                                                      For Cheques Only:
NAME OF THE DEPOSITOR                                                                 Date of Presentation:
                                                                                      Date of Realisation:
SIGNAGURE OF THE DEPOSITOR                                                            Branch Name:          STATE BANK OF INDIA MAIN BRANCH GORAKHPUR
                                                                                      Branch Code No.
                                                           (TO BE FILLED IN BY EMPLOYER)
Name of the Bank :                                              Cheque No. :                                       Date :
                                                                  The Employees' Provident Fund Scheme, 1952                                                                Form - 3A
                                                                                       Paragarph 35 & 42
                                                                          Employees' Pension Scheme, 1995
                                                                                          Paragarph 19

       Contribution card for currency period from 1st April                    to 31st March

  1    Account No.                                                                        4          Name & Address of the Factory/ Establishment
  2    Name/ Surname
                                                                                          5          Statutory rate of contribution
  3    Father's/ Husband's Name                                                           6          Voluntary higher rate of employee's contribution
                                                                                                     if any
                                                                                   CONTRIBUTIONS
                     Worker's Share                                      Employer's Share                                                  Period of non
                                                 EPF Difference           Pension Fund                                Refund of
   Month        Amount of                                                                                                                                               Remarks
                                    EPF          between 12% &          (EPS) Contribution      Total                  Wages            From             To
                 Wages
                                                   10% (if any)               8-1/3%
      1               2              3                 4a                       4b               4c                        5              6a             6b                  7
April
May
June
July
August
September
October
November
December
January
February
March
Other
Total                     0.00            0.00                   0.00                    0.00                  0.00            0.00

Certified that the total difference between the total of the contributin shown under col (3) and (4) of the table of reverse and that arrived at on the total wages shown in col (2) at
the prescribed rate is solely due to the rounding off contribution to the nearest rupees under the rules.
          (a) Date of Leaving Service                            (b) Reason for leaving service
Certified that the total amount of contribution (both shares) indicated in this card i.e. Rs.                                                                                    Only
has already been remitted in full in EPF A/c No. 1 and Pension Fund A/c No. 10

Certified that the difference between the total of the contribution shown under cols. 3, 4a and 4b of the above table and that arrived at on the total wages shown in col. 2 at the
prescribed rate is solely due to rounding off of contribution to the nearest rupee under the rules.



                                                                           Signature of the employer or other authorised officer and stamp of the Factory / Establishment
                                                                The Employees' Provident Fund Scheme, 1952                                                        Form - 6A
                                                                                 Paragarph 43
                                                                     Employees' Pension Scheme, 1995

Annual statement of contribution for the currency period 1st April             to 31st March

       Name & Address of the                                                           Statutory rate of contribution   12.00 %
       Establishment
                                                                                       No. of members voluntarily contributing at a higher rate:
       Code No. of Establishment

                                                      Wages retaining
                                                                         Amount of
                                                    allowances (if any)                                                                             Rate of
                                                                          Workers          EPF
                                                       & DA including                                    Pension                                    higher
 Sr.                     Name of the Member                             contribution     between                                      Refund of
       Account No.                                   cash value of food                                   Fund            Total                    voluntary      Remarks
 No.                      (in BLOCK letters)                             deducted         10% &                                        Advance
                                                      concession paid                                     8-1/3%                                   contribution
                                                                          from the        8-1/3%
                                                    during the currency                                                                              (if any)
                                                                            wages
                                                           period.
  1          2                      3                         4               5              6               7                             8            9            10




                                  Grand Total Rs.                    0.00       0.00             0.00            0.00          0.00

				
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