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Form-12A Revised EMPLOYEES PROVIDENT FUND AND MISC PROVISIONS ACT 1952 EMPLOYEES PENSION SCHEME PARAGRAPH 20 4 Only for Un-Exempted Establishments st Name and address of the Estt. Currency Period from 1 April. to 31 March. Establishment Status M/s. Statement of contribution for the month of Code No. Particulars To be filled in by the EPFO Group Code Statutory rate of Contribution Wages on which Contributions are payable Amount of contribution Recovered From the Worker Payable by Employer Share Amount of Administrative Charges remitted NIL Worker s Share Date of Remittance enc lose triplicate copies of challan E.P. Form-12A Revised EMPLOYEES PROVIDENT FUND AND MISC PROVISIONS ACT 1952 EMPLOYEES PENSION SCHEME PARAGRAPH 20 4 Only for Un-Exempted Establishments st Name and address of the Estt. Currency Period from 1 April. to 31 March. Establishment Status M/s. Statement of contribution for the month of Code No* Particulars To be filled in by the EPFO Group Code Statutory rate of Contribution Wages on which Contributions are payable Amount of contribution Recovered From the Worker Payable by Employer Share Amount of Administrative Charges remitted NIL Worker s Share Date of Remittance enc lose triplicate copies of challan E*P. F* A/C No* 01 PensionFundA/c N*10 D. L*I. A/C No* 21 Total No* of Employees a Contract b Rest c Total Details of Subscribers No* of subscribers as per last month Nett. Total Number of subscribers Name Address of the Bank in which the amount is remitted. E*P. Currency Period from 1 April. to 31 March. Establishment Status M/s. Statement of contribution for the month of Code No* Particulars To be filled in by the EPFO Group Code Statutory rate of Contribution Wages on which Contributions are payable Amount of contribution Recovered From the Worker Payable by Employer Share Amount of Administrative Charges remitted NIL Worker s Share Date of Remittance enc lose triplicate copies of challan E*P. F* A/C No* 01 PensionFundA/c N*10 D. L*I. A/C No* 21 Total No* of Employees a Contract b Rest c Total Details of Subscribers No* of subscribers as per last month Nett. F* A/C No* 01 PensionFundA/c N*10 D. L*I. A/C No* 21 Total No* of Employees a Contract b Rest c Total Details of Subscribers No* of subscribers as per last month Nett. Total Number of subscribers Name Address of the Bank in which the amount is remitted. E*P. Currency Period from 1 April. to 31 March. Establishment Status M/s. Statement of contribution for the month of Code No* Particulars To be filled in by the EPFO Group Code Statutory rate of Contribution Wages on which Contributions are payable Amount of contribution Recovered From the Worker Payable by Employer Share Amount of Administrative Charges remitted NIL Worker s Share Date of Remittance enc lose triplicate copies of challan E*P. F* A/C No* 01 PensionFundA/c N*10 D. L*I. A/C No* 21 Total No* of Employees a Contract b Rest c Total Details of Subscribers No* of subscribers as per last month Nett. Total Number of subscribers Name Address of the Bank in which the amount is remitted. E*P.

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