8/18/2019 MPJBP0008617000Form3A(20152016)04042016

1/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :RAM SHANKAR SHUKLA R B SHUKLA

 0

0

49170

51482

51482

51482

57282

52932

0

0

0

0

0

5900

6178

6178

6178

6874

6352

0

0

0

0

0

0

5900

6178

6178

6178

6874

6352

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

313830 37660 37660 00 0

%

MP/JBP/00008617/000/0000002

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 75320

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 1 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

2/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :SHIV KUMAR TIWARI A P TIWARI

 0

0

39959

0

0

0

0

0

0

0

0

0

0

4795

0

0

0

0

0

0

0

0

0

0

0

4795

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

39959 4795 4795 00 0

%

MP/JBP/00008617/000/0000003

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 9590

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 2 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

3/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :RAMNARAYAN VERMA N L VERMA

 0

0

36743

37850

37850

37850

42114

38916

38916

38916

38916

0

0

4409

4542

4542

4542

5054

4670

4670

4670

4670

0

0

0

4409

4542

4542

4542

5054

4670

4670

4670

4670

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

348071 41769 41769 00 0

%

MP/JBP/00008617/000/0000004

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 83538

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 3 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

4/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :VADAKKEDATH GOVINDAN KUTT C G KUTTY

 0

0

38383

39554

39554

39554

44010

0

0

0

0

0

0

4606

4746

4746

4746

5281

0

0

0

0

0

0

0

4606

4746

4746

4746

5281

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

201055 24125 24125 00 0

%

MP/JBP/00008617/000/0000006

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 48250

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 4 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

5/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :GORAKHNATH SINGH R P SINGH

 0

0

37850

39000

39000

39000

43396

40099

44369

44369

43369

0

0

4542

4680

4680

4680

5208

4812

5324

5324

5204

0

0

0

3292

3430

3430

3430

5208

4812

5324

5324

5204

0

0

0

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

370452 44454 39454 05000 0

%

MP/JBP/00008617/000/0000007

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 88908

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 5 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

6/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :RAJESH KUMAR SHARMA K R SHARMA

 0

0

33676

34698

34698

34698

38606

35675

35675

35675

35675

0

0

4041

4164

4164

4164

4633

4281

4281

4281

4281

0

0

0

2791

2914

2914

2914

3383

3031

3031

3031

3031

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

319076 38290 27040 011250 0

%

MP/JBP/00008617/000/0000009

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 76580

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 6 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

7/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's Share

Ref. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name : ANNAMMA JOY N M JOY

 0

0

33122

34123

34123

34123

37967

35084

35084

35084

35084

0

0

3975

4095

4095

4095

4556

4210

4210

4210

4210

0

0

0

2725

2845

2845

2845

3306

2960

2960

2960

2960

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

313794 37656 26406 011250 0

%

MP/JBP/00008617/000/0000010

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 75312

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 7 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

8/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :NARESH SHANKAR SHRIVASTVA J M LAL SHRIVASTVA

 0

0

32634

33611

33611

33611

37399

34558

34558

34558

34558

0

0

3916

4033

4033

4033

4488

4147

4147

4147

4147

0

0

0

2666

2783

2783

2783

3238

2897

2897

2897

2897

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

309098 37091 25841 011250 0

%

MP/JBP/00008617/000/0000011

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 74182

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 8 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

9/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :UMESHCHANDRA TIWARI R A TIWARI

 0

0

33122

34123

34123

34123

37967

35084

38938

37011

37011

0

0

3975

4095

4095

4095

4556

4210

4673

4441

4441

0

0

0

2725

2845

2845

2845

3306

2960

3423

3191

3191

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

321502 38581 27331 011250 0

%

MP/JBP/00008617/000/0000014

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 77162

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 9 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

10/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :DWARKA PRASAD GOSWAMI H D GOSWAMI

 0

0

33122

34123

34123

34123

37967

35084

35084

35084

35084

0

0

3975

4095

4095

4095

4556

4210

4210

4210

4210

0

0

0

2725

2845

2845

2845

3306

2960

2960

2960

2960

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

313794 37656 26406 011250 0

%

MP/JBP/00008617/000/0000015

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 75312

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 10 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

11/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name : ALOK KUMAR GOUR R D GOUR

 0

0

33122

34123

34123

34123

37967

35084

35084

35084

35084

0

0

3975

4095

4095

4095

4556

4210

4210

4210

4210

0

0

0

2725

2845

2845

2845

3306

2960

2960

2960

2960

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

313794 37656 26406 011250 0

%

MP/JBP/00008617/000/0000016

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 75312

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 11 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

12/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :DINESH KUMAR SHARMA B P SHARMA

 0

0

29053

29927

29927

0

0

0

0

0

0

0

0

3486

3591

3591

0

0

0

0

0

0

0

0

0

3486

3591

3591

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

88907 10668 10668 00 0

%

MP/JBP/00008617/000/0000017

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 21336

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 12 of 15

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

13/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :SATISH KUMAR SHUKLA R R SHUKLA

 0

0

26156

26945

26944

26944

29980

27703

27703

27703

27703

0

0

3139

3233

3233

3233

3598

3324

3324

3324

3324

0

0

0

1889

1983

1983

1983

2348

2074

2074

2074

2074

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

247781 29732 18482 011250 0

%

MP/JBP/00008617/000/0000019

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 59464

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 13 of 15

FORM 3A (R i d) / FORM 7PS f PF E t d E t bli h t

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

14/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :RAJKUMAR YADAV S L YADAV

 0

0

21513

22173

22173

22173

24673

22798

22798

22798

22798

0

0

2582

2661

2661

2661

2961

2736

2736

2736

2736

0

0

0

1332

1411

1411

1411

1711

1486

1486

1486

1486

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

203897 24470 13220 011250 0

%

MP/JBP/00008617/000/0000020

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 48940

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 14 of 15

FORM 3A (Revised) / FORM 7PS for PF Exempted Establishment

8/18/2019 MPJBP0008617000Form3A(20152016)04042016

15/15

FORM-3A (Revised) / FORM 7PS for PF Exempted Establishment

THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952 (Paras 35 & 42) and THE EMPLOYEES' PENSION SCHEME, 1995 [Para 19]

4. Name and Address of the

Estblishment:5 Statutory rate of the contribution :

1. Account No.

Contribution Card for Currency Period 1ST April 2015 to 31ST March 2016

Month

(1)

Member's Share

Amount of

wages

(2)

EPF

(3)

Pension Fund

8.33%

(4b)

EPF difference between

10% 12% & 8.33%

(4a)

Employer's ShareRef. of Adv.

(5)

NCP

Days

(6)

Remarks

(7)

March Paid in April

May

June

July

August

Sept

Oct

Nov

Dec

Jan

Feb

Feb Paid in March

Total

2. Name 3. Father's/Husband Name :SAJJAN KUMAR BAHELIYA GORELAL

 0

0

15464

15932

15932

15932

17728

16381

16381

16381

16381

0

0

1856

1912

1912

1912

2127

1966

1966

1966

1966

0

0

0

606

662

662

662

877

716

716

716

716

0

0

0

1250

1250

1250

1250

1250

1250

1250

1250

1250

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0 (a) Date of leaving

Service, if any

(b) Reason for

leaving Service, if

146512 17583 6333 011250 0

%

MP/JBP/00008617/000/0000021

 12V. F. J. EMP. CO-OP. SOCIETY LTD

CONTRIBUTION

Note1:(1) in respect of the form 3A sent to the Regional Office during the course of the currency period for the purpose of final settlement of the Account of the member who has

left service, details of date & reasons for leaving service should be furnished under col. 7(a) & (b)

Date :Signature of the employer with office Seal

  (2) in respect of those who are not members of the Pension Fund the employers share of contribution to the EPF will be 12% 10% as the case may be & is to be shown under column 4(a)

Certified that total amount of contribution (both shares) indicated in this card ie. 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 contribution shown under cols 3 and 4a & 4b of the above table are arrived at on the total wages shown in cloumn 2 at the

prescribed rate is soley due to rounding off contributions to the nearest rupee under the rules.

 ADHARTAL JABALPUR JABALPUR MADHYA PRADESH 482,001

 35166

04-Apr-2016

 0

MPJBP0008617000Form3A(20152016)04042016

Contribution rate for A/c 10/2/21/22 changed to - / - / - / - Wage ceiling is changed to staturatory/disabled 15000/-

Page 15 of 15