Employees Provident Fund Scheme

Form 6-A

[Paragraph 43 of the Employees’ Provident Funds Scheme, 1952 and Paragraph 20(4) of the Employees’ Pension Scheme, 1995)

Consolidated Annual Contribution Statement

Annual statement of contribution for the currency period
from 1st 20 to 20

Statutory rate of contribution

No. of Members voluntarily subscribing at a higher rate

Name and address of the Factory/Establishment

Code No. of the Establishment

Sl. No. / Account No. / Name of the Member (in block letters) / Wages, Retaining allowance (if any) and D.A. including cash value of food concession paid during the currency period
1 / 2 / 3 / 4
Amount of worker’s Contribution deducted from the wages / Employer’s Contribution / Refund of Advances / Rate of higher voluntary contribution (if any) / remarks
E.P.F deference between 10% & 8 1/3% / Pension Fund 8 1/3%
5 / 6 / 7 / 8 / 9 / 10
Reconciliation of Remittances / Total Rs. / Rs. / Rs. / Rs.

Amount Remitted

Sl. No. / Month / Amount Remitted EPF Contribution including refund of advances A/c No. 1 / Pension Fund Contribution A/c No. 10 / EDLI Contribution A/c No. 21 Rs. / (Admn. Charges Rs. At 0.65% of wages) / Aggregate Contributions cols. 5+6+7 Rs. ( )
1 / Rs. / Rs. / Rs. / Admn. Charges A/c No. 2 Rs. / EDLI Admn. Charges 0.001% Rs.
2 / Rs. / Rs. / Rs.
3 / Rs. / Rs. / Rs.
4 / Rs. / Rs. / Rs.
5 / Rs. / Rs. / Rs.
6 / Rs. / Rs. / Rs.
7 / Rs. / Rs. / Rs.
8 / Rs. / Rs. / Rs.
9 / Rs. / Rs. / Rs.
10 / Rs. / Rs. / Rs.
11 / Rs. / Rs. / Rs.
12 / Rs. / Rs. / Rs.
Total / Rs. / Rs. / Rs.
  1. Total number of contribution cards enclosed (Form 3-A Revised)
  2. Certified that Form 3-A duly completed of all the members listed in this statement are enclosed, except those already sent during the course of the currency period for the final settlement of the concerned member’s account vide ‘Remarks’ furnished against the names of the respective members above.

Signature of Employer (with Office Seal)