Form 12 (Revised)

By Yolanda Stewart,2014-05-06 03:54
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Form 12 (Revised) Form 12 (Revised)

    Employees Provident Fund Scheme

    Form 12 (Revised)

    Paragraph 38(2) of the Employees’ Provident Funds Scheme, 1952

    Statement of Contribution for the month of 20

    Name and address of the establishment Code No. of the Establishment

Total Wages Amount of contributions due as per recoveries made in the

    No. of on wages/ acquittance register subscriwhich

    bers contribu

    tions Worker’s Share Employer’s Share


    recoverEPF FPF Total EPF FPF Total ed 1 1/6% 1 1/6%

    (a) (b) (c) (a) (b) (c)

    1 2 3 4

    Amount of contributions remitted in Account Nos. 1 and 10

     Worker’s Share Employer’s Share Total

    EPF FPF Total EPF FPF Total

     1 1/6% 1 1/6%

    (a) (b) (c) (a) (b) (c)

    5 6 7 8

    1. Total amount remitted in Account No. 1 Rs

     Date of remittance

    2. Total amount remitted in Account No. 10 Rs

     Date of remittance

    Amount of Adm. Charges Amount of Adm. Charges Date of remittance due 0.37% of the amount remitted in A/c No.2

    of wages shown in

    Column 2

    9 10 11 Name and location of the Whether the triplicate Remarks bank in which remitted or challan receipt is

    No. and date of the enclosed, if not, state

    cheque/draft sent to reason

    Regional Officer

Account No. 1

    Account No. 10

    Account No. 2

No. as per last month’s return

    (+) No. of New Subscriber vide Form 5

    (-) No. of Subscribers left service vide Form 10

    *Net Total

    This should tally with the figure given at the top right hand corner of this Form.

     Total No. of Employees

     Contract Rest Total

     Total No. of Subscribers

     stCurrency period from 1 April, 20 st To 31 March, 20.

    Statutory Rate of Contribution

    No. of members voluntarily contributing at higher than the statutory rate

    Signature of the Employer

    Date (with official seal)

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