FORM 6A

THE EMPLOYEES' PROVIDENT FUND SCH

(PARAGRAPH 43)
and
THE EMPLOYEE'S PENSION SCHEME
( PARAGRAPH 20 (4))
ANNUAL STATEMENT OF CONTRIBUTION
for the currency period from
1st March' 2006 to 28th February' 2007

Name & Address of the establishment

Code No: of the establishment

Wages,
retaining
allowance
(if any)
and DA
including
S.NO Account Number NAME OF THE MEMBER cash value
of food
concessio
n paid
during the
currency
period.

1 2 3 4
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76

GRAND TOTAL -
 FORM 6A
S' PROVIDENT FUND SCHEME, 1952
(PARAGRAPH 43)
and
YEE'S PENSION SCHEME, 1995
PARAGRAPH 20 (4))
STATUTORY RATE OF CONTRIBUTION : 12%
No. of members voluntarily NIL
contributing at a higher rate NIL

Amount of
Worker's
contributio Rate of
ns higher
Refund of
deducted Employer's contribution w.e.f. 16/11/1995 voluntary Remarks
advance
from the contributio
wages on n (if any)
10% /
12% EPF

EPF Pension Fund contribution 8.33%

difference
between
10% /
12% &
8.33%
5 6 7 8 9 10
- - -
Only for un-exempted establishment FORM 12-A (REVISED)
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 January 2008
Statutory rate of contribution for the month of January 2008

CODE NO
Particulars Wages on which Amount of Contribtion Amount of Contribution remitted
contributions are 3 4
payable Recovered from Payable by Worker's share Employer's Share
the workers the employer
1 2
E.P.F. A/C NO. 01 0 0 0 0
PENSION FUND 0 NIL 0 NIL 0
A/C NO. 2&10
E.D.L.I. A/C NO.21&22 0 NIL 0 NIL 0
Total No of Employees
(a)Contract Name & Address of the
(b)Rest Bank in which the amount
(c) Total 0 is remitted
Details of Subscribers E.P.F. Pension Fund
No.of Subscribers as perlast month 0
No.of New Subscribers (Vide Form5) 0
No.of Subscribers left service (Vide Form 10) 0
(Nett) Total Number of Subscribers 0 0
 (To be filled by the EPFO)
C PROVISIONS ACT 1952

Establishment status
uary 2008 Group Code

Amount of Amount of Date of remittence

adminitrative adminitrative (enclose triplicate copies of
charges charges challan)
due remitted
5 6 7
0 0 18 | 02 | 2 0 0 8 |
NIL NIL 18 | 02 | 2 0 0 8 |

0 0 18 | 02 | 2 0 0 8 |

STATE BANK OF INDIA,PONDICHERRY

EDLI 0
0
0
0
0
Signature of employer
with official(Seal)
 COMBINED CHALLAN OF A/C No. 1,2,10,21 & 22 Original / Duplicate / Triplicate / Quadruplicate
STATE BANK OF INDIA

EMPLOYEE'S PROVIDENT FUND ORGANISATION

(USE SEPARATE CHALLAN FOR EACH MONTH)

ESTABLISHMENT CODE NO. ACCOUNT GROUP NO ………...…… PAID BY CHEQUE / CASH ……………..………

Employees Share D D M M Y Y
DUES FOR THE MONTH OF:
Employer Share 0 0 0 0 DATE OF PAYMENT

TOTAL NO. OF SUBSCRIBERS

A/c 1 A/c 10 A/c 21
TOTAL WAGES DUE

SL. PARTICULARS A/C No. 1 A/C No 2. A/C No. 10 A/C No. 21 A/C No.22 TOTAL
…………….……. AMOUNT (IN RUPEES) ………...…………

1 EMPLOYER'S SHARE OF CONT. 0

2 EMPLOYEE'S SHARE OF CONT. 0

3 ADM. CHARGES 5 2 7

4 INSP. CHARGES

5 PENAL DAMAGES

6 MISC. PAYMENT (PAST

ACCUMULATIONS ONLY)
TOTAL 0 5 0 0 2 7

(AMOUNT IN WORDS) Rs. Only

[FOR BANK'S USE ONLY]
NAME OF ESTABLISHMENT: AMOUNT RECEIVED Rs……...………..………..
FOR CHEQUES ONLY….………………………..
ADDRESS: DATE OF PRESENTATION………....……….…..
DATE OF REALISATION ……………..………….
NAME OF DEPOSITOR ……………………………..…………………………………. BRANCH NAME …….……...…….…...…………..
SIGNATURE OF THE DEPOSITOR ………………...………………………………… BRANCH CODE NO………….….………………..

(TO BE FILLED IN BY EMPLOYER)

NAME OF THE BANK ------------- ### -------- CHEQUE NO -------------------------- DATE