Contributions
Month
Member's share
Employers' share
Refund of advances
Rs. P.
Break in membership / reckonable
Remarks
E.P.F.
Rs.
E.P.F. @ 11/6%
Rs.
Total
Rs.
E.P.F.
Rs. P.
E.P.F. @ 11/6%
Rs. P.
Total
Rs. P.
April, 20...
May
June
July
August
September
October
November
December
January
February
March, 20...
Total
Dated the ..................... 20...................
........................................
Signature of the Employer
(Office Seal)
[FORM 3-A] [Substituted by G.S.R. 1229, dated 22.8.1977]
(For Unexempted Establishments only)
The Employees' Provident Funds Scheme, 1952
(Paragraphs 35 and 42)
And
The Employees' Pension Scheme, 1995
(Paragraph 19)
Contribution card for the currency period from 1st April......20......to 31st March......20......