deZpkjh Hkfo; fuf/k ,oa fofo/k izdh.

kZ mica/k vf/kfu;e] 1952 ds /kkjk 1 4 ds varxZr

LosPNk ls O;kfIr ds fy, vf/kdkak deZpkfj;ksa dk lgefr i=
Consent Letter of Majority of Employees for Voluntary Coverage under Section 1(4)
of the Employees Provident Funds and Miscellaneous Provisions Act, 1952

lsok esa@To,

rkjh[k@Date .

{ks=h; Hkfo; fuf/k vk;qDr@The Regional Provident Fund Commissioner,

___________________________________________
___________________________________________
fok; %

eSllZ ------------------------------------------------------------------------------------- kk[kk,a bR;kfn lfgr dks deZpkjh Hkfo; fuf/k ,oa fofo/k
izdh.kZ mica/k vf/kfu;e 1952 dh /kkjk 14 ds varxZRk foLrkj djus dh lgefr ds fy,

Sub :

Extension of Employees Provident Funds and Miscellaneous Provisions Act, 1952 under Section 1(4)
to M/s (including branches, etc.)
Consent of majority of Employees Regarding

egksn;@Sir,
ge v|ksgLrk{kjh esllZ --------------------------------------------------------------------------------------------------------------------------------------- kk[kkvksa lfgr ds
vf/kdkak deZpkjh d-Hk-fu- vkSj izdh.kZ micU/k vf/kfu;e] 1952 ds varxZRk fn ------------------------------------------------------- ls LoSfNd vk/kkj
ij O;kfIr ds fy, lger gS rFkk ge Hkkjr ljdkj ds xtV esa izdkfkr vf/klwpuk ds varxZr ekg dh vafre frfFk dks vius
fgLls dk Hkfo; fuf/k vaknku dh ------------------------------------ izfrkr dh nj ls nsus dks bPNqd gSA ge opu Hkh nsrs gS fd mDr
fu;e dh vko;drkvksa dks rFkk le; le; ij tkjh lakks/kuksa dk ikyu djsaxsA
We the undersigned majority of employees of M/s .
(including branches etc.) do hereby consent and apply to be covered under the Employees Provident Funds and
Miscellaneous Provisions Act, 1952 on voluntary basis with effect from . the last date of the
month in which the notification is published in the Gazette of India, and we are willing to pay our share of
Provident Fund contribution at the rate of . % We also undertake to abide by the requirements of the
said statute and the rules framed there under as amended from time to time.

2- ge vuqjks/k djrs gS fd deZpkjh Hkfo; fuf/k ,oa fofo/k izdh.kZ micU/k vf/kfu;e 1952 dh /kkjk 14 ds varxZRk vko;d
vf/klwpuk ;Fkkkh?kz tkjh djus dk dV djsaA
We request that necessary notification under Section 1(4) of the Act may be issued at an early date.

Hkonh;@Yours faithfully

Sl No

uke@Name

firk dk uke@Fathers
name

tUe frfFk@Date of
Birth

gLrk{kj@Signature

1
2
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Page 1 of 4

/kkjk 14 ds varxZRk foLrkj djus gsrq eSllZ -------------------------------------------------------------------------------------ds vf/kdkak deZpkfj;ks lgefr i=
tkjh Consent of majority of Employees of M/s ................for
coverage under Section 1(4) (Continued)

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# put additional sheets if so required

fu;ksDrk }kjk vuqizekf.kr

Counter Signed by Employer

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fu;kstd dh lgefr Consent of Employer

eSa@ge ------------------------------------------------------------------------ esllZ --------------------------------------------------------------------------------------------------------------------------ds Lokeh@funskd@Hkkxhnkj] Hkkjr ds jkTki= esa fnukad ------------------------------------ ekg ds vafre fnu dks tc vf/klwpuk izdkfkr
fd;k x;k] ls deZpkjh Hkfo; fuf/k ,oa fofo/k izdh.kZ micU/k vf/kfu;e dh /kkjk 14 ds varxZRk LoSfPNd vk/kkj ij O;kfIr ds
fy, vkosnu djrs gSaA eSa@ge fu;kstd ds :Ik esa bl vf/kfu;e dh /kkjk 6 rFkk 6 ds deZpkjh Hkfo; fuf/k ;kstuk] 1952 ds
iSjk 29 ,oa 38 rFkk dEkZpkjh isaku ;kstuk 1995] ftls iSjk 28 ,oa 39 rFkk deZpkjh Hkfo; fuf/k ;kstuk 1952 ds iSjk xzkQ 38
,oa 39 ds varxZRk ;FkkizcU/k izHkkj ds lkFk i<+k tk,] ds varxZRk rFkk izko/kku fd;k x;k gSA ------------------------------------ izfrkr dh nj
ls Hkfo; fuf/k rFkk isaku fuf/k vaknku ds esjs@gekjs fgLls dk Hkqxrku djus dk ,rn~}kjk opu nsrs gS rFkk le; le; ij
rFkk lakksf/kr lkafof/kd rFkk mlds varxZr cukbZ xbZ fu;eksa ds lHkh izko/kkuksa rFkk krksZa dk ikyu djrs gSaA
I/We.
for
the
Proprietor/Director/Partner of M/s.. do hereby apply for coverage
under Section 1(4) of the Employees Provident Funds and Miscellaneous Provision Act, 1952 on voluntary
basis with effect from.the last date of the month in which the Notification is
published in the Gazette of India. I/We, as employer(s), do hereby undertake to and will pay my/our share of
Provident Fund and Pension Fund contribution at the rate of .%, as provided under Section 6 and 6A
of the said Act read with paragraph 29 and 38 of Employees Provident Funds Scheme, 1952 and paragraph 4 of
Employees Pension Scheme.1995 and Administrative charges as provided under paragraphs 38 and 39 of
Employees Provident Funds Scheme.1952 and to abide by all provisions and requirements of the said status
and the rules frame there under as amended from time to time.

2- vf/kdre deZpkjh vaknku ds vius fgLls ----------------------------- izfrkr dh nj ls Hkqxrku djus ds fy, bPNqd gS rFkk deZpkjh
Hkfo; fuf/k ,oa izdh.kZ micU/k vf/kfu;e rFkk mlds varxZr cukbZ xbZ ;kstuk ds micU/kksa ds vuqikyu djus ds fy,
lger gSaA bl laca/k esa mudh fyf[kr lgerh layXu gSA
The majority of the employees are willing to pay their shares of contributions at the rate of . % and
have agreed to comply with the provisions of the Employees Provident Funds and Miscellaneous Provisions
Act, 1952 and the Scheme framed there under. The written consent to this effect is enclosed.

3- eSa@ge fu;kstu ds :Ik esa ge oknk djrs gS fd ge deZpkjh fu{ksi lgc) chek ;kstuk] 1976 ds vaknku dks mDr fu;e
dh /kkjk 6 x] ftls mDr Ldhe ds iSjk 7 ds lkFk i<+k x;k gS] ds varxZr rFkk mfYyf[kr 0-5 izfrkr dh nj ls rFkk
;kstuk ds iSjk 3 ds varxZr rFkk fd;k x;k gSA Ikzkkfd izHkkj 0-01 dh nj ls Hkqxrku djsaxs rFkk lHkh izko/kkuksa o
vko;drkvksa] lafof/kd rFkk le; ij mlds varxZr cuk, x, fu;eksa dk ikyu djsaxsA
I/We, as employer(s) do hereby undertake to and will pay the Employees Deposit Linked Insurance
Scheme. 1976 Contributions at the rate of 0.5% as provided under Section 6C of the said Act read with
paragraph 7 of the said Scheme and Administrative Charges at the rate of 0.01% as provided under
paragraph 3 of the Scheme and to abide by all provisions and requirements and the statute and the rules
framed there under from time to time.

4- eSa@ge ;g Hkh vkoklu nsrs gS fd deZpkjh Hkfo; fuf/k ,oa fofo/k izdh.kZ micU/k vf/kfu;e] 1976 ds varxZr cukbZ xbZ
;kstuk ds v/khu ykHkksa dks esjs@gekjs vU; kk[kkvksa@dk;kZy;ksa@deZpkfj;ksa@,ddksa@foHkkxksa@QSfDV;ksa esa dk;Zjr
deZpkfj;ksa dks c<+k,axsA ij mfYyf[kr laLFkkuksa esa fu;ksftr vf/kdre etnwjksa us Hkh dqy deZpkfj;ksa ds vf/kdkak
deZpkfj;ksa us ^lgefr* nh gSA
I/We, also undertake and agree to extend the benefits under the Scheme framed under the Employees
Provident Funds and Miscellaneous Provisions Act, 1952 to the employees employed in my/our other
branches/offices/units/departments/factories. The majority of the workers employed in the above mentioned
concerns have also subscribed to the consent by the majority of total employees.

5- eq>s@gesa fu;kstd dks ds :Ik esa etnwjksa ds vaknku dh nj -------------------------- izfrkr nsus ds fy, dksbZ vkifk ugha gS] rFkk
eSa@ge deZpkjh Hkfo; fuf/k ;kstuk] 1952 ds iSjk 39 dEkZpkjh fu{ksi lgc) chek ;kstuk] 1976 ds iSjk 8 varxZRk
le;&le; ij dsUnzh; ljdkj }kjk rFkk fu/kkZfjr vko;d izkklfud izHkkjksa ds Hkqxrku djus dh ftEesnkjh ysrs gSA
I/We, as employer(s) have no objection to the workers, contribution at the rate of.. %
and I/We, undertake to pay the necessary administrative charges as fixed by the Central Government from
time to time under paragraph 39 of the Employees Provident Funds Scheme, 1952 and paragraph 8 of the
Employees Deposit Linked Insurance Scheme, 1976.

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6- dsUnzh; Hkfo; fuf/k vk;qDr ds }kjk vf/kfu;e dh /kkjk 14 ds varxZr vko;d vf/klwpuk tkjh djus ds fy, vko;d
O;koLFkk djasA
Necessary Arrangements may kindly be made to issue the necessary notification under Section 1 (4) of the
Act, by the Central Provident Fund Commissioner.

Seal

Hkonh;@Yours faithfully

fu;kstd dksa dk gLrk{kj@Signature of Employer(s)

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