FORM-5 THE EMPLOYEES’ PROVIDENT FUNDS SCHEME, 1952 [Paragraph 36 (2) (a)] AND THE EMPLOYEES' PENSION SCHEME, 1995 [Para - 20 (4)] artardt wftrer Fife ete, 1995 raat 36 (2) (@) sire arterft dart eta, 1995 [eet 20 (4)] 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 of ....... 1.20 ‘we, 20 aha elt are aster far Fae, aterét eer Pain ote aeserét meer ate Pir & een at a act are werd a Rach (To be sent to the Commissioner with Form 2 (EPF & EPS) axa es 2 (@orterét fre Pir et afer er PAAR) Baer orgERT wt oT OTE Name and address of the Factory/Estt..... taeda a AF ToT Code No, of Factory/Establishment....n deetirarat at ais Fo ‘SI. | Account Name of the Father's Name |Date} Sex | Date of ies petted of No. | _ No. Employee (in (or husband's | of | fait | joining revious service we. | den block capitals) name in case | birth the Funa | 8 05 the date of aregfter a. ater oT Aaliied | Se ff wt | Fund (Enclose ae (RIS Soren NR way | Scheme cortti- wed 3) fret a are wd a | _cate lf aplcabi) (Prete ret a a ae rt a oft a aT) i a fate ae Pract aa ft ga oat (ao aT oe war ae aft ary 8) ee 3 4 s |e 7 8 ° Signature of the Employer or other authorised officer of the Factor/Establishment Stamp of the FactoryEstt es np of the Factory/Est eri sr Preteen at srt snftege ofrert & wera daetveasa at shee