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

S.NO

Wages, retaining allowance (if any) and DA including cash Number NAME OF THE MEMBER value of food concessio n paid during the currency period.

EPF difference between 1 1

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

2

3

4

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 voluntarily contributing at a higher rate

Amount of Worker's contributio ns deducted from the wages on 10% / 12% EPF

Employer's contribution w.e.f. 16/11/1995

NIL NIL

Rate of higher Refund of voluntary Remarks advance contributio n (if any)

EPF difference between 10% / 12% & Pension 8.33% Fund contribution 8.33% 5

6

7

8

9

10

-

-

-

Only for un-exempted establishment

FORM 12-A (REVISED) (To be filled by the EPFO) 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

contributions are payable

Amount of Contribution remitted

3

4

Recovered from

Payable by

the workers

the employer

1 2 E.P.F. A/C NO. 01 PENSION FUND 0 A/C NO. 2&10 E.D.L.I. A/C NO.21&22 0 Total No of Employees (a)Contract (b)Rest (c) Total Details of Subscribers No.of Subscribers as perlast month No.of New Subscribers (Vide Form5) No.of Subscribers left service (Vide Form 10) (Nett) Total Number of Subscribers

Worker's share

Amount of itrative

Employer's Share charges due

0 NIL

0 0

0 NIL

0 0

5 0 NIL

NIL

0

NIL

0

0

0

Name & Address of the Bank in which the amount is remitted E.P.F. Pension Fund 0 0 0 0 0

STATE BANK OF INDIA,PONDI

EDLI 0 0 0 0

(To be filled by the EPFO) ONS ACT 1952

Establishment status Group Code

Amount of

Date of remittence

itrative (enclose triplicate copies of charges

challan)

remitted

6 0 NIL

7 18 | 02 | 2 0 0 8 | 18 | 02 | 2 0 0 8 |

0

18 | 02 | 2 0 0 8 |

STATE BANK OF INDIA,PONDICHERRY

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. DUES FOR THE MONTH OF:

GROUP NO

………...……

Employees Share Employer Share

TOTAL NO. OF SUBSCRIBERS TOTAL WAGES DUE SL. PARTICULARS

PAID BY CHEQUE / CASH D

0

0

0

D

M

Y

Y

DATE OF PAYMENT

0

A/c 1

A/c 10 A/C No. 1

M

……………..………

A/c 21

A/C No 2. A/C No. 10 …………….……. AMOUNT

A/C No. 21 A/C No.22 ………...…………

TOTAL

(IN RUPEES)

1 EMPLOYER'S SHARE OF CONT.

0

2 EMPLOYEE'S SHARE OF CONT.

0

3 . CHARGES

0

4 INSP. CHARGES 5 PENAL DAMAGES 6 MISC. PAYMENT (PAST ACCUMULATIONS ONLY) TOTAL

0 (AMOUNT IN WORDS) Rs.

0

0

0

0

0

Only [FOR BANK'S USE ONLY]

NAME OF ESTABLISHMENT: ADDRESS: NAME OF DEPOSITOR ……………………………..…………………………………. SIGNATURE OF THE DEPOSITOR ………………...…………………………………

AMOUNT RECEIVED Rs……...………..……….. FOR CHEQUES ONLY….……………………….. DATE OF PRESENTATION………....……….….. DATE OF REALISATION ……………..…………. BRANCH NAME …….……...…….…...………….. BRANCH CODE NO………….….………………..

(TO BE FILLED IN BY EMPLOYER) NAME OF THE BANK ------------- ###

-------- CHEQUE NO

--------------------------

DATE