Contributions
Month
Workers' share
Employers' share
Refund of advances
No. of days / period of service non -contributing service (if any)
Remarks
Amount of wages
EPF
EPF difference between *[12%
and 10%], if any
Pension Fund contribution *[10%]
1
2
3
4
4b
5
6
7
March paid in April, 20...
May
(a) Date of leaving service, if any,
(b) Reason for leaving service, if any
June
July
August
September
October
November
December
January
February paid in March, 20...
Total
Certified that the total amount of contributions (both shares) indicated in this card, i.e., Rs ............ has already been remitted in full in EPF A/c No. 1 and Pension Fund A/c No. 10........ (vide Note below).
Certified that the difference between the total of the contributions shown under columns (3) and (4)(a) and (4)(b) of the above table and that arrived at on the total wages shown in column (2) at the prescribed rate is solely due to the rounding off of contributions to the nearest rupee under the rules.
Dated the ..................... 20...................
..............................................
Signature of Employer
(Office Seal)
Note.-(1) In respect of the Form 3-A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the accounts of the members who has left service details of date and reasons for leaving service, should be furnished tinder column 7(a) & (b).
(2)
In respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be *[10% to 12%] as the case may be, and is to be shown under column 4(a).
FORM 4
The Employees' Provident Funds Scheme, 1952
(Paragraphs 35 and 42)
Contribution card for employees other than monthly paid employees for the period from ..............................to...............................