PF Ready Reckoner

2012

Employees Provident Fund and Misc. Provisions Act, 1952 Ready Reckoner

Written by M Ravi Shankar, mravimtnl@gmail.com

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PF Ready Reckoner

Written by M Ravi Shankar

Dedicate to all the unknown gurus on Internet who helped me in learning various subjects.

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PF Ready Reckoner
Index
1 2 3 4 5 6 Introduction Enrollment Compliances EPF Calculations/benefits EPS Calculation/benefits Withdrawal/Advances

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PF Ready Reckoner Introduction

The Employees' Provident Fund & MP Act,1952 is an important piece of Labour Welfare legislation enacted by the Parliament to provide social security benefits to the workers . At present , the Act and the Schemes framed there under provides for three types of benefits -Contributory Provident Fund , Pensionary benefits to the employees/ family members and the insurance cover to the members of the Provident Fund. The object of the Act in 1952 was to institute the compulsory contributory Provident Fund to the employees to which both the employee and the employer would contribute. The Employees' Provident Fund Scheme was accordingly framed under the Act and it came into effect from 1-11-1952. On a review of the working of the scheme over the years by EPFO, it was found that in the event of the premature death of the employees the accumulation in the Provident Fund were too meagre to the family of the deceased .Thus another social security benefit of providing Family Pension through the Employees' Family Pension Fund Scheme , 1971 was introduced by amending the Act . At this stage, the Act was renamed as "The Employees' Provident Fund & Family Pension Act, 1952" and the Employees' Family Pension Scheme came into force on 1-3-1971. The Act was further amended in the year 1976 to introduce another social security benefit to provide an insurance cover to the members of the Provident Fund in covered establishment. The Employees' Deposit Linked Insurance Scheme, 1976 came into force from 1-8-1976. The name of the Act was then changed to the present one i.e. 'The Employees' Provident Fund & MP Act, 1952. From 16-111995, the Employees' Pension Scheme has come into force which provides pension to retiring employees on reaching 50/58 years of age, widow pension, children pension and nominee pension on death of the member to his eligible family members. This replaces the Employees' Family Pension Scheme 1971.

Employee Provident Fund Organization is the nodal agency for administration of the fund as well as statutory authority under the Act to ensure Compliances. EPFO had Launched online receipt of Electronic Challan cum Return (ECR) from the Month of April 2012 (March paid in April. Through, this portal registered employer can upload the Electronic Return and the uploaded return data will be displayed through a digitally signed copy in PDF format. The employer may choose to make the payment through internet banking of SBI or take a print out of the Challan and pay at any designated branch of State Bank of India (SBI). The Benefits of this portal are as follows:: No paper returns to be prepared and submitted to EPFO. No need to submit other returns viz Form 5/10/12A,3A and 6A Employers will get the confirmation of payment through SMS instantly.

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PF Ready Reckoner
The contribution will be credited to the members' account on monthly basis. Employers can view the annual accounts slip for accounting year 2011-12 online. For earlier years employers can request for the annual slips through this portal.

Though the EPFO has provided many features in its portal, still the employers have to preserve Physical Copies of Forms Such as Form 2 (Nomination form) Form 5/10 (to be provided to members after joining/ leaving the service) and Form 3/3A (to be used for filling Form 10 C /D or Form 19 for withdrawal of Pension). Further, claiming benefits under EPF Act is not yet made online. Therefore, in the subsequent chapters of this book, procedures on how to fill the form, the relevant provisions pertaining to the form are explained. The First part of book deals with the compliances that are required to be made by the employer. The second part deals with benefits and withdrawals.

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PF Ready Reckoner

Enrollment
The EPFO Act is applicable to a factory or establishments engaging more than 20 workmen. In order to obtain coverage under EPFO Act, the Contractor shall submit an application to PF office in the Form for Proforma of coverage (Template given in Next page): Attachments Required along with Proforma of Coverage: 1. Memorandum & Articles of Association with Certificate of Incorporation/Partnership Deed as applicable. 2. Copy of Work Orders 3. Labor License 4. Copy of Company PAN 5. Bank a/c existing Certificate 6. Copy of VAT/ST Registration 7. Copy of Factory/Shop & Comm. Est Registration 8. DD/Cheque for One month advance contribution 9. Copy of Trade license 10. First Sales Invoice/ Commencement of Business Certificate issued by the Registrar of Companies. As proof of date of commencement 11. Proof of Residence: rent agreement/Electricity Bill etc

Procedure 1. The form to be submitted to PF office 2. The Concerned enforcement Officer will visit the establishment for verifying the Original records 3. Thereafter EPF will assign the code. 4. Advance Contribution for two months is required to be paid for coverage. Point to be noted before submission of Form 1. If workmen are more than twenty, a separate sheet should be attached along with the form. 2. Balance sheet is to be attached to determine actual date of coverage. 3. Date of Incorporation will be in Certificate of Incorporation 4. Illustrative Form The Illustrative sheet given in the Next page pertains to ABC Company with employee strength of 20 workmen Proforma for Coverage

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Performa for Coverage ( to be submitted by an employer along with one or more of the documents mentioned below for obtaining Code Number) 1. 2. Name of the establishment/factory and address. Details of Head Office and branches with address. ABC Company Limited 804, SAI KRUPA BUILDING, VASHINAKA, CHEMBUR, MUMBAI-400074 MH/19116

This field need not be filled for first time registration of Company

3. 4.

Details of Code No. if any allotted to the Head Office.

5.

6. 7.

Date of Incorporation/Set up (Please furnish any 05.06.2010 one of the documents mentioned overleaf in support of the proof of date of set up of the The date of est./factory) incorporation will be in the Certificate of Incorporation Employment Strength 20 At present : (ii)Month wise employment strength from the date of set up may be furnished in separate statement : Nature of business activity/ manufacturing Construction/Civil activity : Details of legal set up of the establishment Private (Please mention whether it is an incorporated Private or Public Limited Company, Society, Partnership or Proprietary concern) :

8.

Details of the employers/ownership particulars etc. (Names, Designation and Addresses of Managing Director, Directors, Partners, Secretary etc. to

be furnished) : 9. Wages disbursed for the month 10. Details of Bankers: (Including Bank Branches & Account Number (s).) 11. Income Tax Permanent A/c. No.

P H Patil 804, SAI KRUPA BUILDING, VASHINAKA, CHEMBUR, MUMBAI-400074 July 2012 SBI, MAHUL, CHEMBUR MUMABI AABPS1205E.

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PF Ready Reckoner
Sl.N o. Name of the employee Fathers Name Date of Joining Wages (basic +DA & Cash value of Food Concession)
6500 5500 6500 4500 6500 6500 3500 6500 6500 6500 8500 6500 6500 9000 6500 6800 6500 6500 6500 6500

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

Chhya R Dagde Eknath K Jore Madhav Manikar Nenu N Bagv Nitin Suravanshi Poonam Munde Rajkumar N Kagda Sanjay B ukande Santosh J shirke Vijay D Wagmare Vilas B sable Yogesh S Salve Prashant A Bhilarew Anil Y Mihsra Basavaraj k himatre G Krishan Naidu Vemal R Bhale rao Chinta Appa Rao Dianmaran C Hanumanta Mudakappa

Eknath R Dagde Nitin K Jore Cheyya Manikar Madhav N Bagv Nitin Suravanshi Ashok Munde Vijay N Kagda Sunil B ukande Sanjay J shirke Vilas D Wagmare vinod B sable Bhaskar S Salve Prateek t A Bhilarew Ajay Y Mihsra Dinesh k himatre G Appala Naidu Ajayl R Bhale rao Chinta Sanjeev Rao Dinakaran C Vinay Mudakappa

05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010 05/04/2010

Fill the detail of Workmen engaged by the company

Fill the details of DD Number and Amount

(In case you have more than 21 employees the above information in respect of the other employees may be added in a separate sheet of paper in the same format continuing the serial number. ) 12. Details of bank draft amounting to the contribution. Name SBI, Mahul of the Bank Branch & And administrative charges paid in Chembur respect of the above employees. (Rate of Contribution at Branch present is12% by employer and employees+ 0.5% DD No:33675 towards E.D.L.I. contribution and 1.15% towards Amount:99840 administrative charges VERIFICATION The details furnished above are correct to the best of our knowledge and belief. It is clearly understood that we are liable for coverage from a date antecedent to the date of set up furnished above in the event of furnishing of false information. (signature) Employer. Sign of Employer Required

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PF Ready Reckoner
Enrolment of Employees After registration under EPF Act, the employee should be enrolled under the EPF/EPS/EDLI scheme by submitting Form 2 i.e. Nomination Form under Para 33 & 61(1) of EPF Scheme 1952 and paragraph 18 of Employees Pension Scheme, 1995. Nominees under Employees Provident Fund Scheme Male Members : his wife, his children, his dependent parents and his deceased son's widow and children Female Members: her husband, her children, whether married or unmarried, her dependent parents, her husband's, dependent parents, her deceased sons widow and children;

Nominees under Employees Pension Scheme Male Members : his wife, Sons & Daughters (includes legally adopted) Female Members: her husband, Sons & Daughters (includes legally adopted) ** Dependent parents cannot be made as dependent in EPS scheme

Point to be noted before submission of Form 1. A member can distribute the amount in his nomination form 2. If a member has a family at the time of making a nomination, the nomination shall be in favour of one or more persons belonging to his family. Any nomination made by such member in favour of a person not belonging to his family shall be invalid. Fill in the required details in the fileds from 1 to 7, except 6. 3. In total there are three tables/ schedules in each form: a. First table (Part A) should be filled with the details of either parents or Spouse. (If married). b. Second table (Part B) should be filled only if employee is not married else empty. - Table 2 c. Third table (Part B) should be filled only if employee is married else empty.. Table 3

Illustrative Form
The illustrative form given in the next page is of a married person wherein he has distributed EPF benefits among his dependent parents and EPS benefit to his wife.

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PF Ready Reckoner
(For Unexempted /Exempted Establishments) NOMINATION AND DECLARATION FORM FORM 2 (Declaration and Nomination Form under the Employees Provident Funds and Employees Pension Scheme) (Paragraphs 33 & 61 (1) of the Employees Provident Funds Scheme, 1952 and paragraph 18 of the Employees Pension Scheme, 1995) 1 2 3 4 5 6 7 Name (in Block Letters) Fathers/Husbands Name Date of birth Sex Marital Status Account No. (PF/EPS Number) Address (Residential) : : : : : : : Eknath Ram Shelke Laxman untru shelke 15/4/1988 Male Married MH/19116/809 Permanent Block No- 04, Sadgur Apratment, Devalali, Thane

Temporary Sai Darpar Apartment, Vashinak Chembur PART A (EPF) I hereby nominate the person(s)/cancel the nomination made by me previously and nominate, the person(s) mentioned below to receive the amount standing to my credit in the Employees Provident Fund, in the event of my death:
Name and Address of the nominee/ nominees Address Nominees relationship with the member Date of Birth Total amount or share of accumulatio ns in Provident Fund to be paid to each nominee (%) If the nominee is a minor, name and relationship and address of the guardian who may receive the amount during the minority of nominee

(1) Laxman Munda Shleke Block No- 04, Sadgur Apratm ent, Devalali , Thane Mother

(2)

(3) (4) 01/05/196 50% 8

(5) NA

Put Cross Mark at point 1 if you have a family and Point 2 if your parents are dependent

100%

2 3.

* Certified that I have no family as defined in para 2(g) of the Employees Provident Funds Scheme, 1952, and should I acquire a family hereafter, the above nomination should be deemed as cancelled. * Certified that my father/mother is/are dependent upon me. * Strike out whichever is not applicable.

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PF Ready Reckoner
Remember to take sign of the Subscriber
---------------------------------------------------------------------Signature or thumb impression of the subscriber

Note: - A Fresh nomination shall be made by the member on his marriage and any nomination made before such marriage shall be deemed to be invalid # If Married > Spouse, Children (married or unmarried), his/her dependent parents, deceased sons widow and children. If unmarried then Parents, Brother, Sister or any other person(s). Page No. 1 Please fill details of parents Part B (EPS) (Para 18) $
if not married.

I hereby furnish below particulars of the members of my family who would be eligible to receive widow/children pension in the event of my death. Sl.No. Name and address of the family members Date of Birth Relationship with the member (1) (2) (3) (4) 15/4/1989 Wife 1 Sumanta Shelke ** Certified that I have no family, as defined in para 2(vii) of Employees Pension Scheme, 1995 and should I acquire a family hereafter I shall furnish particulars thereon in the above form. I hereby nominate the following persons for receiving the monthly widow pension (admissible under para 16 2(a) (i) and (ii) of Employees Pension Scheme, 1995 in the event of my death without leaving any eligible family member for receiving Pension. Name and Address of the Nominee (1) Sumanta Shelke Dated the :______________ **Strike out whichever is not applicable. Date of Birth (2) 15/4/1989 Relationship with the member (3) Wife Signature / thumb impression of the subscriber

CERTIFICATE BY EMPLOYER

Remember to take sign of the Subscriber

Certified that the above declaration and nomination has been signed/thumb impressed before me by Shri/Smt./KumariEknath Ram Shelke_employed in my establishment after he/she has read the entries/the entries have been read over to him/her by me and got confirmed by him/her.
Place: ___________________ Dated the __________________ . Signature of the Employer or other authorised Officer of the establishment Designation. Name and address of the Factory/Establishment or rubber stamp thereof

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PF Ready Reckoner
Form No.11: Declaration on EPF Subscription: Form 11 under EPF scheme pertains to information provided by an employee while joining a new employer, about his previous employments with name and address of employers along with duration of service. In this form a new joinee also declares that whether he was previously a member of EPF scheme or not. This form is to be kept by an employer and not to be deposited with Sub/Regional commissioner. EPF inspector while inspecting records of an establishment may ask for these forms to check the eligibility criteria. The Form 11 of EPF is a declaration by the employee for certifying that wherever has worked/or not worked, he never had a PF account number. The EPFO has introduced this form in order to stop the system of having multiple numbers of one employee. Duties of Employer
34. Declaration by persons taking up employment after the Fund has been established The employer in relation to a [factory or other establishment] shall, before taking any person into employment, ask him to state in writing whether or not he is a member of the Fund and if he is, ask for the Account Number and/or the name and particulars of the last employer. If he is unable to furnish the Account Number, he shall, require such person to furnish and such person shall, on demand, furnish to him for communication to the Commissioner, particulars regarding himself and his nominee required for the Declaration Form. Such employer shall enter the particulars in the Declaration Form and obtain the signature or thumb impression of the person concerned: Provided that in the case of any such employee who has become a member of the Family Pension Fund under the Employees Family Pension Scheme, 1971, the aforesaid Declaration Form shall also contain such particulars as are necessary to comply with the requirements of that Scheme.

As per Paragraph 34 of EPF Scheme, Employer shall take an undertaking from the member in Form 11 that employee was not enrolled earlier in the scheme. If the employee is previously enrolled, the employer should insist the member to submit the details of his previous account and fill the same in Form No 11. In case an employee is already member of phased out Family pension scheme 1971, the details of same are also required to be furnished Point to be noted before submission of Form 1. Points (a) to (d) in the form 11 are required to be filled in case the employee is earlier member of the scheme 2. Point (e) in the form 11 is required to be filed only in the case the member is not enrolled earlier in the PF Scheme.

Illustrative form: The form given in the next page is of a new entrant who wan not a member of PF Scheme earlier. Therefore all fields are kept blank except 1 (e) which is tick marked

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PF Ready Reckoner
FORM-11 (For unexempted Establishment only) Paragraph 34 of the Employees Provident Funds Scheme, 1952 Declaration by a person taking up employment in an establishment in which the Employees Provident Fund and Family Pension Fund Scheme are in force : I Vikas Praksh Ghodke (Name) ** son/wife/daughter of Prakash B Ghodke do hereby solemnly declare that (a) I was last employed in________Company left service on 1/5/2010 (Prior to that I was employee of from to date (b) I was a member of of the Family Pension Fund from / / Provident Fund and also/but not and my account number(s) was/were

to

(c) I have /have not withdrawn the amount of any Provident fund/Family Pnsion Scheme. (d) I have/have not drawn any superannuation benefits in respect of my past service from any employer.

(e) I have never been a member of any Provident Fund and/or Family Pension Scheme.

Date

Signature or **right/left hand thumb impression of the employee.

Put a Tick Mark in case employee is not a member earlier in this scheme

(To be filled in by the employer only when the person employed had not already been a member of the Employees Provident Fund) Shri Vikas Praksh Ghodke (name) is appointed as Rigger (Designation) in ABC Company(Name of the Factory/Establishment) with effect from 01.05.2010(Date of appointment) Date of completion of 120 actual working days in a period of 6 months or less or six months* continuous service or date of confirmation whichever is earliest. Date of admission as member of Employees Provident Fund

From 01.05.2010 to 01.11.2010 No. of days worked

Account No. Signature of the Employer or Manager or other Authorised Officer. Date ** Strike out whichever is not applicable. N.B. The principal employer should have filled it up also in respect of employees to be employed by or through a contractor.

(For Unexempted Establishment only) Contract Total No. of Employees Total No. of Subscribers Rest Total

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PF Ready Reckoner

Contributions
The Contribution payable by employer and employee is provided in Section 6, 6-A & 6-B of the EPFO Act.

Relevant provision

Section 6: Contributions and matters which may be provided for in Schemes. The contribution which shall be paid by the employer to the Fund shall be ten percent. Of the basic wages, dearness allowance and retaining allowance, if any, for the time being payable to each of the employees whether employed by him directly or by or through a contractor, and the employees contribution shall be equal to the contribution payable by the employer in respect of him and may, if any employee so desires, be an amount exceeding ten percent of his basic wages, dearness allowance and retaining allowance if any, subject to the condition that the employer shall not be under an obligation to pay any contribution over and above his contribution payable under this section: Provided that in its application to any establishment or class of establishments which the Central Government, after making such inquiry as it deems fit, may, by notification in the Official Gazette specify, this section shall be subject to the modification that for the words ten percent, at both the places where they occur, the words 12 percent shall be substituted: Provided further that where the amount of any contribution payable under this Act involves a fraction of a rupee, the Scheme may provide for rounding off of such fraction to the nearest rupee, half of a rupee, or quarter of a rupee. Explanation I For the purposes of this section dearness allowance shall be deemed to include also the cash value of any food concession allowed to the employee. Explanation II. For the purposes of this section, retaining allowance means allowance payable for the time being to an employee of any factory or other establishment during any period in which the establishment is not working, for retaining his services.

Interpretation

The PF Contributions payable shall be paid by the employer to the fund shall be ten/twelve percent of basic wages, dearness allowance including cash value of food concession, retaining allowance and the employee contribution shall be equal to employers contribution.

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PF Ready Reckoner
The Amount of Contribution is divided in to three schemes as follows: Scheme Name Employee provident fund Employees Pension scheme Employees Deposit linked insurance EPF Administrative charges EDLIS Administrative charges Total Employee contribution 12% 0 0 0 0 12% Employer contribution 3.67% 8.33% 0.5% 1.1% 0.01% 13.61%

Calculation of Contribution Let us calculate the contribution of an workman who is getting a minimum wage of Rs 236.30 per day. The wages payable for a month will be Rs 6149 (236.30 X 26 days) Contribution Towards EPF Employees share EPS Employer share EPF employer share EDLI charges payable by employer EPF Admin charges payable by employer EDLI Admin charges payable by employer Calculation 6149 x 12% 6149 x 8.33% 6149 x 3.67% 6149 x 0.5% 6149 x 1.1% 6149 x 0.01% Amount 738 512 226 31 68 .61

In case, the salary of employee is more than Rs 6500 then the PF Contribution payable by employer is only limited to Rs 6500/- only as per Para 2 6 A (2) of PF Scheme, Para #(2) of EPS Scheme and Para 7 of EDLI Scheme. In such a scenario the following method may be adopted to pay their contributions. Consider an employee getting a basic salary of 7500/Contribution Towards EPF Employees share EPS Employer share EPF employer share EDLI charges EPF Admin charges EDLI Admin charges Calculation 7500 x 12% 6500 x 8.33% 6500 x 3.67% 6500 x 0.5% 6500 x 1.1% 6500 x 0.01% Amount 900 541 239 33 72 0.65 ( Round up to Rs 1/-)

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PF Ready Reckoner
Points to be noted: The employee has option to join or not to join PF Scheme in case his salary is more than Rs 6500 The minimum wages and special allowances notified by appropriate government can not be further bifurcated for payment of PF Contributions . Mode of Payment An Electronic Challan Cum Return should be generated in the esewa portal of EPFO for payment of Contribution Amount. The Contributions of employee as well as employer shall be remitted in State Bank of India thru cheque or DD drawn in favor of EPFO along with Electronic Chalaln Cum. The ECR consists of the following fields: : Contribution Towards Establishment Code Account Group A/c 1 A/c 10 A/c 2 A/c 21 A/c22

Details of Account Code/Number allotted by department to your Company Payment towards Provident fund Contributions Payment towards Pension Admin charger for PF and And Pension for all employees Payment towards EDLI Admin charges for EDLi

Calculation PF

Employer 3.67% and Employee 12% Employer *8.33% Total employer contribution* 1.10% Employer contribution @ 0.5% (Basic +Da) A/c21 *0.5%

The remittance shall be made within 15 days of close of every month i.e. by 15 th of the following month of payment of salary

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PF Ready Reckoner Compliance

Form 5: Para 36 (2) (a) of EPF Scheme: (2) Every employer shall send to the Commissioner within fifteen days of the close of each month a return(a) in Form 5, of the employees qualifying to become members of the Fund for the first time during the preceding month together with the declarations in Form 2 furnished by such qualifying employees, and (c) provided further that a copy of the forms mentioned in clause (a) and (b) above shall be provided by the employer to concerned employees immediately after joining of the service or at the time of leaving of the service as the case may be (7)Every employer shall send to the Commissioner such returns in electronic format also, in such manner and form as may be specified by the commissioner Interpretation: By 15th of every Month Form 5 along with form 2 shall be submitted. Such Form 5 shall consist information of the new employees who have joined the scheme. Vide Notification date 4th May 2012, Form 5 shall be submitted electronically (ie in ECR text file Form 5 is getting submitted). However, a physical copy should be provided to the employee. Employees Provident Fund Scheme Form 5 [Paragraph 36(2)(a) of the Employees Provident Funds Scheme, 1952 and Para 20(4) of the Employees Pension Scheme, 1995] 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 July 2012 (To be sent to the Commissioner with Form 2 (EPF & EPS) Name and Address of the Factory/Establishment: ABC COMPANY LIMITED, 804, SAI KRUPA
BUILDING, VASHINAKA, CHEMBUR

Code No. of Factory/Establishment: MH/19116

Account No Name of Employees in Block Letters Fathers name (or Husbands name in case of married woman) 12.4.81 Date of birth Sex Date of Joining of the fund
Total period of previous service as on the date of joining the Fund (Enclose Scheme certificate if applicable

SL No

Rem arks

MH/19116/23

POONAM MUNDE

GUDDI MUNDE

10.4.2010

Signature of the Employer or other authorized officer of the Factory/Establishment Date .. Written by M Ravi Shankar, mravimtnl@gmail.com Stamp of the Factory/Establishment Page 17

PF Ready Reckoner
Compliance-II :Form-10 Para 36 of EPF Scheme: (2)Every employer shall send to the Commissioner within fifteen days of the close of each month a return-: (b) [in such form as the Commissioner may specify], of the employees leaving service of the employer during the preceding month: Provided that if there is no employee qualifying to become a member of the Fund for the first time or there is no employee leaving service of the employer during the preceding month, the employer shall send a NIL return. ( c) provided further that a copy of the forms mentioned in clause (a) and (b) above shall be provided by the employer to concerned employees immediately after joining of the service or at the time of leaving of the service as the case may be (7)Every employer shall send to the Commissioner such returns in electronic format also, in such manner and form as may be specified by the commissioner

Interpretation: By 15th of every Month Form 10 shall be submitted. Such Form 10 shall consist information of the employees who have left the scheme. Vide Notification date 4th May 2012, Form 5 shall be submitted electronically (i.e., in ECR text file form 10 is getting submitted). However, a physical copy should be provided to the employee. Employees Provident Fund Scheme Form 10 Paragraph 36(2)(a) & (b) of the Employees Provident Funds Scheme, 1952 Return of Members leaving service during the month of Name and address of the Factory/Estt. SL No Account No. Name of Fathers Name (or member (in husbands name in block letters) case of married woman) 3 4
Nitin S Vanshi Vijay K Gaikwad Ravindran K Mahesh Suray Vanshi Prakash K Gaikwad Padmanabhan K

Code No Date of leaving service 5

10/4/2010 15/4/2010 18/4/10

*Reasons for leaving service 6

Attained age of 58 yrs Dismissed Resigned

Remarks

1
1 2 3

2
MH/19116/ 12 MH/19116/ 14 MH/19116/ 20

Signature of the employer or other authorised officer Date : .. Stamp of the Factory/Estt.

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*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) retrenchment, (cc) part of a total disablement due to employment injury, (d) ordinarily dismissed for serious and wilful misconduct, (e) discharged, (f) resigning from or leaving service, (g) taking up employment elsewhere. (The name and address of the Employers should be stated) (h) Death, (I) attained the age of 58 years.

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.2 Shri Vijay K Gaikwad was dismissed from the service for willful misconduct. I recommend that the employer's contribution for Rs 5326 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 Signature of the Employer Compliance-III :Form-3A & 6A Relevant Provisions

40.

Contributions to be entered in the contribution card

The amount recovered every month from the wages of an employee as well as the contribution made by the employer in respect of each such employee shall be entered by the employer every month in the contribution card opened in the name of each member under this Scheme.
Interpretation: The Contribution card will be FORM 3/3-A. The amounts recovered shall be entered in Form 3/3-A 41. Currency of Contribution Cards The contribution cards issued under this Scheme shall be current for one year: Provided that the said period of one year may commence and terminate at such different times, in different [factories and other establishments] as may be decided by the Commissioner from time to time: Provided further that the cards issued a. in respect of the first contribution period, or b. in respect of the contribution period immediately preceding the date from which the establishment is notified as an annually posted establishment, may be for a period which may be less or more than a year.

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PF Ready Reckoner
Interpretation: Form 3/3-A shall be maintained generally for accounting year i.e starting from April to March. If any person joins in between the year his card can be maintained from such month till end of March 42. Renewal of contribution cards An employer shall, on or before the expiration of the period of currency of the contribution card, prepare in respect of each member employed by him a card [in Form 3] [or Form 3A] as may be appropriate, for the next period of currency: Provided that in the case of any such employee who has become a member of the Family Pension Fund under the Employees Family Pension Scheme, 1971, the aforesaid Form shall also contain such particulars as are necessary to comply with the requirements of that Scheme. Interpretation: Fresh Form3/3-A shall be prepared after expiration of each year for every member. In other words Form3/3A is valid for one year only. 43. Submission of contribution cards to the Commissioner Every employer shall within one month from the date of expiration of the period of currency of the contribution cards in respect of members employed by him, send the contribution cards to the Commissioner together with a statement in Form 6: Provided that where a member leaves service, the employer shall send the contribution card in respect of such members before the twentieth day of the month following that in which the members left the service: Provided further that in the case of any such employee who has become a member of the Family Pension Fund under the Employees Family Pension Scheme, 1971, the aforesaid Form shall also contain such particulars as are necessary to comply with the requirements of the Scheme.

Interpretation: Form 3/3A shall be submitted to RPFC within one month of expiration of currency period i.e. April 30th is the last date for submission of Form3/3A along with Form 6/6A to RPFC. If an employee leaves in between the year, then Form 3/3A shall be submitted within 20 of the following month of leaving. However, after launch of e-sewa portal Form 3/3A is not required to be submitted in commissioners office 44. Custody of contribution cards The employer shall retain in his custody the contribution cards in respect of each member employed by him and shall take every precaution against loss or damage of the contribution cards

Interpretation: The employer shall keep the FORM 3/3A in his safe custody.

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PF Ready Reckoner
Para 38 (3) of EPF Scheme:
The employer shall send to the Commissioner within one month of the close of the period of currency, a consolidated annual Contribution Statement in Form 6-A, showing the total amount of recoveries made during the period of currency from the wages of each member and the total amount contributed by the employer in respect of each such member for the said period. The employer shall maintain on his record duplicate copies of the aforesaid monthly abstract and consolidated annual contribution statement for production at the time of inspection by the Inspector.

Interpretation: Form 6A shall be submitted before 30th April of every year. Now Form 3/3A/6/6A will be generated electronically. There is no requirement of Physical submission of the Annual Returns

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PF Ready Reckoner Withdrawals & Benefits

Interest: Relevant Provision
60. Interest (1) The Commissioner shall credit to the account of each member interest at such rate as may be determined by the Central Government in consultation with the Central Board.

Meaning The interest will be decided by Central Board of trustees the Apex Body of EPFO currently chaired by Labor and Employment Minister Mallikarjun Kharge. The interest rate for the year 2011-12 is 8.25% p.a. .

Claiming of Provident Fund

72. Payment of Provident Fund (1) When the amount standing to the credit of a member, becomes payable, it shall be the duty of the Commissioner to make prompt payment as provided in this scheme (5)(a) Every employer shall, at the time when a member of the Fund leaves the service, be required to get the claim application, for payment of provident fund in cases specified in clauses (a) to (dd) of sub-paragraph (1), of paragraph 69, duly filled in and attested, and to forward the said application [within five days of its receipt] to the Commissioner or any other officer authorised by him in this behalf. (b) Every employer shall, at the time when a member of the Fund leaves the service, be required to get the claim application, for payment of provident fund in cases specified in clause (e) of sub-paragraph (1), and in subparagraph (2) of paragraph 69, duly filled in and attested, and to give the said application to the member, for submission, on completion of the period specified in sub-paragraph (2) of paragraph 69, [provided the member continues to remain unemployed in a factory or other establishment to which the Act applies] either through post or in person with proper identification, to the Commissioner or any other officer authorised by him in this behalf. (c) Every employer shall, on the death of the member and on receipt of an application for receiving the amount standing to the credit of such member, forward forthwith [but not later than five days of its receipt] the said application to the Commissioner or any other officer authorised by him in this behalf. (d) If the applicant is unable to send the claim application through the employer or duly attested by him, for any reason whatsoever, he may forward it to the Commissioner or any other officer authorised by him in this behalf, and wherever necessary, the Commissioner or any other officer authorised by him in this behalf may forward such application to the employer and the employer shall be required, to return it within five days of its receipt. (7) The claims, complete in all respects submitted along with the requisite documents shall be settled and benefit amount paid to the beneficiaries within 30 days from the date of its receipt by the Commissioner. If there is any deficiency in the claim, the same shall be recorded in writing and communicated to the applicant within 30 days from the date of receipt of such application. In case the Commissioner fails without sufficient cause to settle a claim complete in all respects within 30 days, the Commissioner shall be liable for the delay beyond the said period and penal interest at the rate of 12% per annum may be charged on the benefit amount and the same may be deducted from the salary of the Commissioner.

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PF Ready Reckoner
Interpretation 1. Employer shall send duly filled in withdrawal form to the PF Commissioner while a member leaves service 2. Employer shall send duly filled in withdrawal form to the PF Commissioner within 5 days of receipt in case of death 3. It is the duty of the commissioner to ensure that claim gets settled within 30 days from date of receipt

Instructions: Form 19 should be filled for withdrawal of provident fund except for death. In case of Death Form 20 should be filled. The fields of both the forms are almost similar except in form 20 the details of claimant and his bank account details needs to be filled and signed by claimant. The example given below is of a resigned employee in Form 19. Sl. Particulars Instructions for furnishing the particulars in form 19 1 Reason for Leaving Service From the following please Indicate the reason applicable to you: 1. Retired from Service after attaining 55 years 2. Retired on Disability to the work 3. Under Voluntary Retirement Scheme 4. Migration to abroad on Permanent settlement 5. Retrenched from Service 6. Resigned / Left Service * * For cases of Resignation / Left Service, the claim should be submitted by the member only after two months from the Date of Leaving Service It is safer to have the payment through cheque. Account Payee cheque will be sent directly to the Scheduled bank / Coop Bank / Post Office in which Savings bank Account of the member is maintained. So, furnish correct SB account number with full address of the Branch of the Bank. wherever applicable furnish the MICR Number also. Please furnish the Xerox copy of the First page of Saving Bank account pass book or monthly statement/Cancelled Cheque wherein the account number and address of the Bank is clearly visible. 3 Contribution for the current financial year Attestation by the Employer In the table provided in Page 3, contribution for the current financial year with wages should be furnished or Form 3/3A for the current financial year with attestation of the employer should be furnished. The authorized official of the establishment should attest the claim under the seal of his designation. It should be ensured, the specimen signature of the attesting official should have been already furnished to the EPFO. Wherever payment is sought through account payee cheque, the advance stamped receipt should be signed by the member duly affixing One Rupee Revenue Stamp. The amount need not be filled in, which shall be filled in by the RPFC / OIC of the EPFO Office. Page 23

Mode of Remittance

Advance Stamped Receipt

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PF Ready Reckoner

Employees Provident Fund Scheme

Form 19
Paragraph 72(5) of Employees Provident Funds Scheme, 1952 Form to be used by a Major Member of Employees Provident Funds Scheme, 1952 for Claiming the Employees Provident Fund Dues : (Refer to Instructions) 1. Name of the member (in Block Letters) : Vikas Praksh Ghodke 2. Fathers Name (or husbands name in the case of married woman) Prakash Bandhu Ghodke . 3. Name and address of the Factory/Establishment in which the member was last employed ABC Company Limited, 804, SAI KRUPA BUILDING, VASHINAKA, 4. 5. 6. 7.
CHEMBUR, MUMBAI-400074 Account No. MH/19916/38

Date of leaving service: 31/06/2010 Reason for leaving service Resigned Full Postal Address (in Block Letters) Shri/Smt/Kumar. : Vikas Praksh Ghodke S/o. W/o: Prakash Bandhu Ghodke, No: 501, BLG:7/A, Vishwa Shanti Bldg, Vashinaka, Chembur, Mumbai, Pin: 400074 Put a tick in the box against the one opted () ( ) to the address given against item No. 7 ( ) S.B. A/c No. in figure: 129000100241065 Name of the Bank: State Bank of India Branch: Chembur (Mumbai) Full Address: Nr Post Office, Ashish Theatre, Chembur, Mumbai

8. Mode of Remittance (a) by postal money order at my cost (b) by account payee cheque sent direct to credit to my S.B./A/c (Scheduled Bank/P.O.) under intimation to me. (Tick here) (Advance Stamped Receipt furnished below)

Certified that the particulars are true to the best of my knowledge. Date of Joining the Establishment : 5/12/2000 Date of Leaving Service:31/6/2010

Contribution for the current financial year Written by M Ravi Shankar, mravimtnl@gmail.com Page 24

PF Ready Reckoner
Employees Share Month Amount of Wages E.P.F Employers Share EPF Cont.(-) Pension Pension Fund Fund Cont. Refund of Adv. Period of Break Remarks

March paid in April 6200 May June July August September October November December January February Feb. paid in March Suppl.( if any) Total

744 744 744 744 744 744 744 744 744 744 744 744 8928

228 228 228 228 228 228 228 228 228 228 228 228 2736

516 516 516 516 516 516 516 516 516 516 516 516 6192

6200 6200 6200 6200 6200 6200 6200 6200 6200 6200 6200 74400

(Information tobe furnished by the employer if the claim form attested by the employer) Certified that the above contributions have been included in the regular monthly remittance. The applicant has signed/thumb impressed before me. Signature of the employer or authorised Official Signature of left/right Thumb impression of the member

Advance Stamped Receipt Remember to take ( Sign of Member Received a sum of Rs* . (Rupees*) From Regional Provident Fund Commissioner/Officer-in-Charge of Sub-Regional Office deposit in my Savings Bank Account towards the settlement of Provident Fund Accout. * The space should be left blank which shall be Provident fund Commissioner/Officer-in-charge Remember to take Sign of Member of the member filled in by Regional of S.R.O. Affix 1 ruppes Revenue Stamps Signature of left/right hand thumb impression

(For the use of Commissioners Office) Written by M Ravi Shankar, mravimtnl@gmail.com Page 25

PF Ready Reckoner
A/c. settled in part/Full Entered in F-21-A/224/29 Withdrawal Register.

Clerk

Head Clerk

(P.I. No.) (M.O./Cheque).. Account No. (Section). Under Rs Passed for Payment of Rs. in words) M.O. Commission If any) Net Amount to be paid by M.O. Accounts Officer Date ..

Paid by inclusion in Cheque No. . dt... Vide Cash Book (Bank) Account No. 10 Debit Item No. . H.C. Remarks Acknowledgment Card AC/RC

Account No.

EPFO

Office of the RPFC/Officer-in Charge of Sub-Regional Office

Acknowledgement Received the following claims. EPF FPF IF Registration No. . Date Office Seal..

In case, no intimation is received within a Month, you may write to the complaints Officer, Employees Provident fund duly quoting the Registration Number and your Provident Fund Account Number

Postcard

Postage Prepaid

. . PIN

Employees Provident fund Organisation Office of the Regional Provident Fund Commissioner/ S.R.O. ..

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PF Ready Reckoner

Pension Benefit
Funding of the Pension Scheme An amount equal to 8.33% of Wages is paid into the EPS from the Employer's contribution. i.e., if a PF member gets Rs. 1000/- as monthly wages and he and his employer contributes 12% each, Rs. 83 goes to Pension Fund. Government also contributes to this Welfare Scheme at the rate of 1.16% of wages. Calculation of pension (A) Those who joined service before 15.11.1995: The formula for calculation of pension for employees who joined service before 15.11.1995 is Past Service Benefit + Pensionable service benefit Proportionate reduction The employee who joined service before 15.11.1995 are divide in to three groups. The three groups are divide basis their as on 16.11.1995. X : those who have not attained 48 years as on 16.11.1995 Y : those who have attained 48 years but less that 53 years as on 16.11.1995 Z : those who have attained 53 years or more as on 16.11.1995 The minimum pension specified for each group i.e. X - Rs.800, Y - Rs.600, Z Rs.500. The pension payable is calculated as follows: Past Service Benefit: Past Service benefit depends upon the wage as on 15.11.1995 and the service rendered. upto 15.11.1995 as shown below: TABLE A Past Service before 15.11.1995 Benefit in Rs. Benefit in Rs. Wages as on Wages as on 15.11.1995 is upto 15.11.1995 is more Rs.2500/ than Rs.2500/80 85 95 105 135 170

Upto 11 years More than 11 years but upto 15 years More than 15 years but less than 20 120 years Beyond 20 years 150

The above amount is the benefit payable on completion of 58 years of age as on 16.11.1995. Written by M Ravi Shankar, mravimtnl@gmail.com Page 27

PF Ready Reckoner
For the calculation of pension benefits before 58 years (if a member do not complete 58 years of age on 15.11.1995, his past service benefit will be increased by the below factor - Early pension cases ) the above benefit is multiplied by the TABLE - B factor to arrive at the past service benefit. Table B If Years to 58 of age from 15.11.1995 is: less than 1 year less than 2 years less than 3 years less than 4 years less than 5 years less than 6 years less than 7 years less than 8 years less than 9 years less than 10 years less than 11 years less than 12 years

then factor is: 1.049 1.154 1.269 1.396 1.536 1.689 1.858 2.044 2.248 2.473 2.720 2.992

If Years to 58 of age from 15.11.1995 is: less than 13 years less than 14 years less than 15 years less than 16 years less than 17 years less than 18 years less than 19 years less than 20 years less than 21 years less than 22 years less than 23 years less than 24 years

then factor is: 3.29 3.621 3.983 4.381 4.819 5.301 5.810 6.414 7.056 7.761 8.537 9.390

2. Pensionable Service benefit= Pensionable salary X Pensionable Service --------------------------------------70 The pensionable salary will be the last drawn salary (Basic+DA which is less than Rs 6500) and Pensionable is the total service. The pension payable is Subject to minimum pension assured by EPF. 3. Proportionate reduction: arises if the past service is less than 24 years and aggregate pension calculated is less that Rs.500/(B) Pension Calculation for Employees who Joined Service after 15.11.1995:

Pension benefit= Pensionable salary X Pensionable Service --------------------------------------70 The pensionable salary will be the last drawn salary and Pensionable is the total service. The pension payable is subject to minimum pension assured by EPF Suppose a workmen has service of 20years and his last drawn pensionable salary is 5000 (Basic+DA which is less than Rs 6500) then the pension benefit is as follows: Pension benefit = 5000 x 20 = 1428 p.m 70 Written by M Ravi Shankar, mravimtnl@gmail.com Page 28

PF Ready Reckoner
Types of Pension: Type of Description Pension Superannuation If age is 58 years or more 20 years or more service Retirement If age is between 50 and 58 years 20 years or more service Short Service If service is more than 10 years (Cessation) Return of If Service is less than 10 years Contribution on exit from employment Calculation Formula As provided in the Formula above As provided in the Formula above

As provided in the Formula above Return of contribution will be provided as per service i.e
Yrs of service 1 2 3 4 5 Return of Contribution 1.02 2.05 3.1 4.18 5.28 Yrs of service 6 7 8 9 Return of Contribution 6.4 7.54 8.7 9.88

Suppose last drawn salary is Rs 5000/-

Widow/Child Pension

Provided to widow and child

Widow pension would be same as he would have received on members date of retirement. In addition to this child would receive 25% of widow pension as child pension.

Disability Pension

Certificate to the effect Would be same as he would have received of permanent and 100% disability on members date of retirement should be produced Commutation not applicable

For withdrawal of pension for service less than 10years Form 10-C is required to be used where as for claim of monthly pension on superannuation/retirement/short service pension/disabled pension/widowed pension/children person/ orphan pension form 10 d should be used. The below given form is an example of Form 10-d of a widower subsequent to her death orphan pension is being given to her children.

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PF Ready Reckoner
Form 10-D The information you should know before you fill claim form seeking settlement under Employees Pension Scheme 1995. If you are a member of pension scheme and If you have less than 10 years contributing service and seek settlement of withdrawal benefit If you are applying for Superannuation pension / Reduced pension / Widow pension / Children / Orphan Pension / Permanent Disability pension If the claimant is minor

Submit claim in Form 10-C

Submit claim in Form 10-D The claim should be submitted by the Natural guardian / Guardian appointed by the Competent court

How to fill Form 10-D claim application Sl. 1

Instructions for furnishing the particulars Please fill the claimants name. If the member is claiming for Retirement / Reduced / Disablement pension, he should fill in his name. The type of pension claimed is to be furnished For Example - Retirement pension or Reduced pension or Widow pension or Children / Orphan pension / Disability pension While furnishing Date of birth, it should tally with Date of birth furnished in Form 9 and other office records. If you want to correct the Date of birth now, documentary evidence such as Birth Certificate / School Certificate / Service records of the establishment duly attested by the employer should be furnished. Date of joining in the Pension Scheme either old pension scheme or new pension scheme should be furnished Date of leaving service be furnished. If the member had attained age of 58 years and still continuing in service, Date of attaining 58 years of age be furnished. Member should mention the Date from which he opts to receive pension in case of reduced pension Reason for leaving service be furnished correctly as (1) Retirement or Superannuation or (3) Resigned / Retrenched or (4) Disablement or (5) Attained 58 years and continuing service (2)

3 (d)

6(a)

6(b)

6(c) 7

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PF Ready Reckoner
9 Facility of Commutation of pension and benefit of Return of Capital are withdrawn. Keep Nil in case of no option Particulars of family of the member be furnished. As per the pension scheme, the spouse and children only are family members. Birth certificates of the children be furnished, if children pension is claimed. If the member is un- married, parents name can be furnished. If the child is disabled, birth certificate and disability certificate from the competent medical officer should be furnished. If the member is deceased, furnish the Date of Death as per the Death certificate. Furnish Death Certificate in original. Details of Savings Bank account with branch address is furnished. If the children pension claimed, separate SB account number for each of the child, who is a minor maintained in the same bank branch of the widow / widower be furnished. Please furnish the Photostat copy of the first page of pass book. If the applicant / claimant is in possession of Scheme Certificate, the original Scheme Certificate should b e s u b m i t t e d r e t a i n i n g a P h o t o s t a t copy, i f necessary. Furnish the control number of the Scheme Certificate. If the claimant is drawing pension under this Scheme, pension payment order number and name of the office which issued the PPO be furnished. The documents enclosed with the claim form should be invariably mentioned individually. The enclosures should be attested by the employer / authorized official of the establishment Wages / Contribution be furnished for a period of 12 months preceding the Date of Leaving / Death. Break-in-Service details for entire period of service be furnished along with the claim application. Descriptive role of the pensioner / claimant be filled correctly and attested by the employer If the establishment is closed, the claim may be attested by any one of the authorized official.

12

13

14

15 16

17

18

19

20

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PF Ready Reckoner
for Office Use Only Inward No. APPLICATION FOR MONTHLY PENSION FORM 10-D(EPS) EMPLOYEES PENSION SCHEME, 1995 (Read INSTRUCTIONS before filling in this Form) 1.By whom the pension is claimed? 2. Type of Pension Claimed.

Major Orphan

Orphan Pension

3.

(a) Member Name (In Block Letters) (b) Sex (c) Marital Status (d) Date of Birth/Age (e) Parent/Spouse Name

: DWARAK JADHAV : FEMALE : WIDOW : 42 : RAMESH : RO SRO Establishment Code No.

4.

E.P.F. Account Number

Memberss Accounts No:

PH/18116/3103
5. 6. 7. 8.
Chembur, Mumbai-400074 Name & Address of the establishment : in which the member was last employed Date of Leaving Service : Not Applicable Reason for leaving Service : Not Applicable Address for communication : Om ganesh Nagar Sainath seva Mandal Vaisnaka, R C Marg Chmebur, Mumbai Abc Company Limited, 804, Sai Krupa Building, Vashinaka,

PIN: 400074

9.

Option for commutation of 1/3 of Quantum: Pension (If option is for lesser) commutation indicate the quantum

Yes

No

Amount

-----

------

-----

Tick No as scheme is phased out Written by M Ravi Shankar, mravimtnl@gmail.com Page 32

PF Ready Reckoner
10. Option of Return of Capital (Please refer Serial Number 10 of INSTRUCTIONS) [Put a Tick ( )] If Yes, indicate your choice of alternative Mention your Nominee for Return of Capital Name Relationship Date of Birth Address 12. Particulars of Family Name Yes No

1 : 2 3

Tick No as scheme is phased out

11.

: : : : : Date of Birth/Age Relationship with Member Indicate against Minor

Not Applicable

SI. No.

Guardian (1) (2) SANAY R JADHAV (3) 22/11/1984 (4) (5)

SON SON

NA NA

Relationship with Member (6) NA

VIKRANT R JADHAV

20/11/1988

NA

Note : If any child is physically handicapped, please indicate DISABLED below the name. 13. Date of death of Member (if applicable) Details of Saving Bank Account Opened Name of the Bank Name of the Branch Full Post all Address 31140646055 STATE BANK OF INDIA MAHUL ROAD, CHEMBUR, MUMBAI 17/11/2008

14.

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PF Ready Reckoner

SI.No

Name of the Claimants(S)

Saving Bank Accounts No. 31140646055 31140646054

1 2

SANAY R JADHAV VIKRANT R JADHAV

14(A) If the claim is preferred by nominee, indicate his/her (1) Name : (2) Relationship : with the deceased Member 15. Details of Scheme Certificate

Not Applicable

Scheme Certificate received & enclosed Not Received Not Applicable

NA NA NA

Already in possession of the Member, if any If received, indicate:

SI. No

Scheme Certificate Control No.

Authority who issued the Scheme certificate

NA

NA

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PF Ready Reckoner

16.

If Pension is being drawn Under E.P.S., 1995

PPO No. issued by

RO

SRO

17.

Documents enclosed (Indicate as per the Instructions) 1.death certificate 2.pass book 3.canclled cheque 4. 5. 6. 7. 8. 9. 10.

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PF Ready Reckoner
TO BE SUBMITTED IN DUPLICATE IN RESPECT OF EACH PERSON ELIGIBLE FOR PENSION

Descriptive of Pensioner and his/her Specimen Signature/Thumb impression 1. 2. 3. 4. 5. 6. 7. 5 9. Name of the Member E.P.F. Account Number Name of the Pensioner Father/Husband name Sex Nationality Religion Height Personal Marks of Identification : : : : : : : : :

DWARAK R JADHAV MH/18116/3103 SANJAY RAMESH MALE INDIAN BUDDHA Remember to take 3 5 specimen 1. Black mark on head signatures 2.
1 2 3

10.

Specimen signature of Pensioner

10.

(Only in the case of illiterate Claimant (Pensioner) Left Hand Finger Impression); THUMB INDEX MIDDLE RING SMALL Signature Name of attesting Authority Official Seal:

Place : Date : Certified that: (i) (ii) I am not drawing Pension under Employees Pension Scheme, 1995: The particulars given in this application are true and correct.

Remember to take 3 specimen signatures

Signature of the applicant / Left hand Thumb Impression

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PF Ready Reckoner
(TO BE FILLED IN BY THE EMPLOYER / AUTHORISED OFFICER OF THE ESTABLISHMENT)

Certified that: (i) (ii) the particulars of the member are correct; the particulars of Wages and Pension Contribution for the period of 12 months preceeding the date of leaving service are as under :(In case, the wages is not earned for all 12 months, the block of 12 months will commence backwards from the last drawn)

Year

Month

Wages

Pension

(1) 2007

(2)

Jan Feb Mar April May June July August September Ocober November

No of Days (3) 19

Amount (4) 2682 (5)

Details of period of noncontributory service. If there is no such period, indicate Nil Year No.of days for which no wages were earned (6) (7)

223 265 154 Fill the details as mentioned in Form 3/3A

22 15

3182 2097

08 09 19 18 14 16 03

1157 1302 2748 2598 2021 2310 433

139 108

216 168 192 36 ------23 days------------131 days--------

Encls:

1. 2.

Documents as given in the Instructions. Form of descriptive roll and specimen signature.

Signature of Employer/ Authorised Official of The Establishment with Seal & Date

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Page 37

(FOR OFFICE USE ONLY) (PENSION SECTION / ACCOUNTS SECTION)

Certified that the particulars in the application have been verified with the relevant concerned documents. The claimant is eligible for Pension. The Input Data Sheet is placed below for approval. Entered in Form 9/Form 3(PS), Master Ledger Card/Claim Inward Register Form 2(R) enclosed along with the documents furnished by the claimant.

CLERK date

S.S date

A.A.O Date

A.P.F.C date

FOR USE IN PENSION PRE-AUDIT CELL The Input data sheet verified with reference to the application and the documents enclosed and found correct. P.P.O. may be generated through Computer. CLERK date S.S Date A.A.O Date A.P.F.C(Pension) date

FOR USE IN PENSION DISBURSEMENT SECTION

P.P.O. No Date of issue to the Bank Intimation sent to the Claimant and also to Accounts Branch on

CLERK date

S.S date

A.A.O Date

A.P.F.C date

Hindustan Petroleum Corporation Limited

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PF Ready Reckoner

Withdrawal/Advances

Withdrawals: Types of Benefit The purchase of site for construction of house Eligibility 5 Years of membership of the Fund (Minimum balance in members a/c should be Rs. 1000/-) * The purchase should be in favour of member or member & spouse. The Construction 5 Years of of House membership of the Fund Eligible Amount Form Documentary Support 24 months wages No.31 A declaration from the member (Basic & DA) that, dwelling site or dwelling OR house/flat or the house under Members own construction is free from share of encumberances and the same is contribution + under the title of the member or Companys share the spouse (notification dated of Contribution 25.2.2000) with interest thereon

The purchase of dwelling flat

36 months wages No.31 A declaration from the member (Basic+DA) that, dwelling site or dwelling OR house/flat or the house under Members own construction is free from (Minimum balance share of encumberances and the same is in members a/c contribution + under the title of the member or should be Rs. Companys share the spouse (notification dated 1000/-) of contribution 25.2.2000) * The purchase with interest should be in thereon favour of member or member & spouse. 5 Year of 36 months wages No.31 A declaration from the member membership of the (Basic+DA) that, dwelling site or dwelling Fund OR house/flat or the house under Members own construction is free from (Minimum balance share of encumberances and the same is in members a/c contribution + under the title of the member or should be Rs. Companys share the spouse (notification dated 1000/-) of contribution 25.2.2000) * The purchase with interest should be in thereon favour of member or member & spouse.

Hindustan Petroleum Corporation Limited

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PF Ready Reckoner
Additions, Alterations or improvements to the dwelling house 5 years from the 12 months basic date of completion or members own of dwelling house share of contribution with thereon. No.31

Advance: 68 BB : REPAYMENT OF LOAN Types of Benefit Advance from the fund for repayment of loan Eligibility 10 years membership of the fund & member should have taken loan from Govt. Body Eligible Amount Form Documentary Support

36 month wages (Basic No.31 A certificate from the + DA) lending authority OR furnishing the details of Members own share of loan and outstanding Contribution + amount. Companys share of Contribution with interest thereon.

68 J : ADVANCE FROM FUND FOR ILLNESS Types of Benefit Advance from the fund for illness viz. hospitalisation for more than a month, major surgical operation or suffering from TB, Leprosy, Paralysis, Cancer, Heart ailment etc. Eligibility Stay in Hospital at least for a month Eligible Amount 6 moths wages (Basic + DA) Form Documentary Support No.31 A certificate from the Medical Practitioner for hospitalisation or operation.

68 K : ADVANCE FROM THE FUND FOR MARRIAGE Types of Benefit Advance from the fund for Marriage of self/son/daughter/ sister/brother etc. Eligibility 7 years membership of the fund & minimum balance in members account should be Rs. 1000/Eligible Amount Form 50% of members own share of contribution Documentary Support No.31 Declaration by the member which is attested by the employer.

Advance from the fund for education of Son/Daughter 68L : ADVANCE IN ABNORMAL CONDITIONS

Hindustan Petroleum Corporation Limited

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Types of Benefit Eligibility Eligible Amount Rs. 5000/- or 50% of members own share of contribution (To apply within 4 months) Documentary Support No.31 l Certificate from the Appropriate Authority. Form

Grant of advance in Certificate of abnormal conditions, damage from Natural calamities etc. appropriate authority.

68 M : ADVANCE TO MEMBER AFFECTED BY CUT IN THE SUPPLY OF ELECTRICITY Types of Benefit Grant of advance to members affected by cut in the supply of electricity Eligibility The advance may be granted only to a member whose total wages for any one month commencing from the month of January 1973 were 3/4th or less than 3/4th of wages for a month Eligible Documentary Form Amount Support Wages No.31 Certificate from State for a Govt. regarding cut in month the supply of OR electricity. Rs.300/-

68 N : GRANT OF ADVANCE TO MEMBERS WHO ARE PHYSICALLY HANDICAPPED Documentary Support To Physically Production of medical Basic wages+ DA No.31 Certificate from the Handicapped member certificate from a for six months Medical practitioner to for purchase of an competent medical or own share of the effect that the equipment required to practitioner to the contribution with member is physically minimize the hardship effect that he is interest or cost of handicapped.. on account of handicap. physically handicapped equipment which ever is least. Types of Benefit Eligibility Eligible Amount Form

Form No 31 shall be filled for withdrawal or taking advance from EPFO for any of the above reasons. An illustrative form 31 is provided below.

Hindustan Petroleum Corporation Limited

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EMPLOYEES PROVIDENT FUNDS SCHEME,1952

FORM NO 31
APPLICATION FOR ADVANCE FROM THE FUND

: Amount of advance required Rs 50,000/-In Words fifty Purpose for which advance is thousand only Required: Marriage of Daughter 1. 2. 3. Name in full ( in block letters) Fathers/Husbands Name Name of the factory/establishment in which employed and address Provident Fund Account No. Monthly basic wages and DA : Raman Shelke : Laxman Shelke : ABC Company, Om ganesh Nagar, Sainath seva Mandal Vaisnaka, R C Marg, Chmebur, Mumbai : PH/18116/05 : BASIC 6500 6. Full postal address of the member to which payment/intimation to be sent D.A. 1000 TOTAL 7500

4. 5.

8/604, PC Lane, Indira Nagar, Govandi

PIN:400074 7.
(a)

MODE OF REMITTANCE :
In case of advance for purchase of site/house/flat or construction through an agency-or repayment of housing loan, indicate (i) in whose favour the cheque is to be drawn ( ii ) Full address :In other cases, put a tick ( ) against any one of the following : (b) (c) By account payee cheque through the employer (to the address given against Sl. No.3. By deposit in bank account no.31000059765(Name of the Bank) State Bank India located Govandi (Full postal address) opp Nr. Post Office, Mahul, Chembur, Mumbai By money order at my cost to the address given against SL. No. 6. *I declare that the advance is required to meet the expenses in connection with my marriage / marriage of my son/daughter/brother/sister. Shri/Kumari Ms Lakshmi (Name) 21 (aged) to be celebrated on 10 Aug 2012 (date) at address 8/604, PC Lane, Indira Nagar, Govandi.

(d)

I declare that the above particulars are true to the best of my knowledge and I will abide by the conditions governing the grant of advance under the Scheme. Certificates/documents in support of my application is/are furnished/enclosed. Date : Station : Signature/left /Right/hand thumb impression of the member Remember to take signature of * Delete if the advance applied for is not for marriage employee Hindustan Petroleum Corporation Limited Page 42

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ADVANCE STAMPED RECEIPT [ To be furnished with reference to 7(a) or (b) or (c) above only] Received a sum of Rs. Fifty thousand (Only) from the Regional Provident Fund Commissioner/Officer in charge of Sub-Regional Office/Sub-Accounts Office, Employees ProvidentFund towards the grant of advance from my Employees Provident Fund Account maintained by him. * (To be filled in by the EPF Office)
Affix Re. 1/Revenue Stamp Signature of the member

[ TO BE FURNISHED BY THE EMPLOYER] During closure/lock out of the factory/establishment by any Gazetted Officer or the Chief Executive/ Head of a local authority or M.P. or M.L.A. or member CBT/ Regional Committee, EPF.

sign of
Certified that the application has been signed by the member in my presence after he/she had read the employer contents/ the contents have been explained to him/her by me and that the information given in the application is correct. Required certificate(s) is/are enclosed.

Date_______________ Designation of the signing official with Stamp of the Factory/establishment Encls.:________________________

Signature of the employer or an authorised official of the factory/establishment

FOR USE IN PROVIDENT FUND COMMISSIONERS OFFICE Section _____________________________________ Account No.____________________ ( AUTHORITY FOR PAYMENT OF ADVANCE UNDER PARA 68 ) Passed for payment of Rs.______________ Rupees ________________________________________only Mode of remittance ( Refer S.No. 7 ) M.O. Commission, if any Net amount to be paid by money order P.l. No. Clerk : Section Supervisor Vide payment scroll P.C. to A.A.O./A.P.F.C. A.A.O./A.P.F.C.

FOR USE IN CASH SECTION Paid by inclusion in Cheque No._________________________________dated the ______________vide Cash Book Account No. 1 debit item No.____________________________________________________

Clerk

Section Supervisor

Assistant Commissioner

REMARKS

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INSTRUCTIONS
A MEMBER OF THE FUND MAY AVAIL THE FOLLOWING WITHDRAWALS/ADVANCE 1. PURCHASE OF A DWELLING SITE : ( From an Agency Original allotment order) From an individual : Original Title deed, non -encumbrance certificate ( for verification and return ) agreement with the seller. PURCHASE OF DWELLING HOUSE/FLAT : ( From An AgencyOriginal Allotment Order ) From an individual : Original title deed for (verification and return), agreement with the seller, non-encumbrance certificate. CONSTRUCTION OF A HOUSE : Original Title Deed (for Verification and Return ),non-encumbrance certificate ,estimated cost of construction,Approved Plan. Note :- While claiming the second and subsequent installments, the declaration/certificate as required by the Commissioner in his letter sanctioning the advance should be submitted along with the application. Agency referred to in 1 to 3 would above mean, Central/ State Government, a Co-operative Society, an Institution, a Trust, a local body or a Housing Finance Corporation. In case of Transactions through an agency the payment will be made only by Account payee cheque, direct to the Agency concerned. 4. ADDITIONS, ALTERATIONS OR IMPROVEMENT TO THE HOUSE OWNED BY MEMBER OR BY SPOUSE OR JOINTLY MEMBER AND SPOUSE: (Approval of the appropriate authority, estimate of the work, original title deed of the house ( for verification ), non-encumbrance certificate , a certificate from the appropriate authority specifying the date of completion of the house). REPAYMENT OF HOUSING TO LOAN TO STATE GOVT. HOUSING BOARD, MUNICIPAL CORPORATION OR A BODY SIMILAR TO DELHI DEVELOPMENT AUTHORITY.: ( A certificate from the lending authority furnishing the details of loan and outstanding amount).

2.

3.

5.

ON ATTAINMENT OF AGE OF 54 YEARS OR WITHIN ONE YEAR BEFORE RETIREMENT : (Date of birth/age of the member and due date of retirement should be furnished by the employer) CLOSURE /LOCKOUT OF THE FACTORY/ ESTABLISHMENT, FOR THE REASONS OTHER THAN STRIKE : ( Furnish the Certificate A given overleaf ) NON RECEIPTS ON WAGES FOR 2 MONTHS FOR REASON OTHER THAN STRIKE: (Furnish Certificate B given overleaf.) Hindustan Petroleum Corporation Limited Page 44

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DISCHARGE OR DIMISSAL OR RETRENCHMENT ARE CHALLENGED BY THE MEMBER-THE CASE IS PENDING IN THE COURT OF LAW ( A copy of the petition filed by the member in the court of law and certificate from the advocate that the case is pending in the Court of Law, should be furnished.) ILLNESS OF MEMBER/FAMILY MEMBER : (Furnish Certificate C given overleaf.) MARRIAGE OF SELF/SON/DAUGHTER/SISTER BROTHER : ( Furnish a declaration in Form 31 ) POST MATRICULATION EDUCATION OF SON/DAUGHTER : ( Certificate from the institution regarding the course of study and anticipated expenditure ) DAMAGE TO THE PROPERTY DUE TO NATURAL CALAMITY(FLOOD/RIOT/EARTH QUAKE) : (Furnish the Certificate D given overleaf. AFFECTED BY CUT IN ELECTRICITY : ( Furnish the Certicate E given overleaf ) PURCHASE OF EQUIPMENT FOR PHYSICALLY HANDICAPPED MEMBERS : Furnish the Certificate F given overleaf NOTE :Such other documents, Certificate etc. as may be required by the sanctioning authority are also required to be furnished. In case no intimation received within a month, please write to R.P.F.C./officer in charge of SubRegional office. through the establishment. In case the advance granted for the purpose at SL. NO. 1 to 3 above is misused the amount of the advance granted will be recovered with penal interest and no further advance under the paragraph shall be granted for a period of three years from the date of grant of said advance. In case of misuse of the advance granted for marriage the amount of advance will be recovered with penal interest.

1. 2.

3.

4.

CERTIFICATE A CLOSURE /LOCKOUT OF THE FACTORY/ ESTABLISHMENT FOR THE REASONS OTHER THAN STRIKE Certified that the establishment has been closed down/locked up for reasons other than strike. Certified that no compensation was not paid to the member Sh/. Smt.______________________________________________________for the period of Lock Out/Closure.

Signature of the Employer /Authorised Official With date & seal CERTIFICATE B NON RECEIPTS ON WAGES FOR 2 MONTHS FOR REASON OTHER THAN STRIKE Certified that the member Sh./Smt.______________________________________has not received his wages for a continuous period 2 months or more i.e. from _____________to_____________________for reasons other than strike.

Signature of the Employer /Authorised Official With date & seal

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CERTIFICATE C ILLNESS OF MEMBER/FAMILY MEMBER I. Certified ( i ) The member Sh./ Smt. ___________________________ has/ had been granted leave for a period of_______________________ from _____________to _________________ The E.S.I. facilities/Cash benefits are not actually available to the member/ the member has ceased to be eligible for cash benefits under E.S.I. (Certificate from E.S.I. enclosed )

II.

Signature of the Employer/ Authorised Official With date & seal MEDICAL CERTIFICATE TO BE ISSUED :1. 2. 3. In case of major surgical operation or where the Hospitalisation for one month or more had or has become necessary the Doctor of the Govt. E.S.I./ Private Hospital . In case of Treatment of T.B/ Leprosy/ Paralysis or cancer By a Doctor of Govt./Private Hospital E.S.I./or by a Regd. Medical Practitioner. In case of Treatment of heart ailment or mental derangement: By a specialist Doctor.

Certified that Shri/Smt./Kumari______________________S/o.W/o.D/o____________________________ I. is suffering from T.B./Leprosy/Paralysis/Cancer/Mental Derangement/Heart ailment. II. is suffering from ____________________________________( disease)for which a major surgical operation /and hospitalisation for a period of ____________________day from ___________to___________________________has or had become necessary. III. is suffering from _____________________________and hospitalisation for a period of ________days from ________________________ to _____________________had or has become necessary. *Delete if not applicable CERTIFICATE - D Signature of Doctor with dated Seal

DAMAGE TO THE PROPERTY DUE TO NATURAL CALAMITY(FLOOD/RIOT/EARTH QUAKE)

Certified that the movable/immovable property of Sh._____________________________ situated at_______________________has been damaged due to ____________________________on date_______________________. The estimated loss of property due to calamity is valued at Rs.______________________The State Govt. has declared that calamity has effected the general public in the area in which the property of the member is/was located vide Notification/press release no. and date _________________

Signature of Employer/Revenue official/Gazetted Officer/ M.L.A./M.P./Member of C.B.T. /Regional Committee with seal and date CERTIFICATE - E CUT IN ELECTRICITY Certified that the fall in wages amounting to 25% more than 25% of wages in respect of Sh./Smt ./Kumari______________________is due to power cut Signature of Employer/authorised official with dated seal CERTIFICATE F PURCHASE OF EQUIPMENT FOR PHYSICALLY HANDICAPPED MEMBERS Medical Certificate from a competent Medical practitioner: Certified that Sh./Smt./Kumari__________________________________S/o/W/o/D/o____________________________is physically handicapped viz_____________________and requires the equipment viz. ( nature of handicap)_________________________ costing about Rs._______________to minimise the hardship on account of handicap.

Signature of the Doctor with Date and Seal

Hindustan Petroleum Corporation Limited

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Hindustan Petroleum Corporation Limited

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