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Form 12A Format

This document is a Form 12A which is used to report contributions to the Employees' Provident Fund and Miscellaneous Provident Fund Act in India. It provides details of contributions made by an employer for a specific time period, including the number of employees, wages paid, and amounts contributed to the EPF, pension fund, and EDLI for that time period. The form also includes details like the employer name and address, bank account numbers, and number of new and leaving employees. It must be signed by the employer and submitted to update contribution records for the specified month.

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890 views1 page

Form 12A Format

This document is a Form 12A which is used to report contributions to the Employees' Provident Fund and Miscellaneous Provident Fund Act in India. It provides details of contributions made by an employer for a specific time period, including the number of employees, wages paid, and amounts contributed to the EPF, pension fund, and EDLI for that time period. The form also includes details like the employer name and address, bank account numbers, and number of new and leaving employees. It must be signed by the employer and submitted to update contribution records for the specified month.

Uploaded by

jaipalme
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd
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FORM - 12A

THE EMPLOYEES’ PROVIDENT FUND AND MISC. PROVIDENT ACT, 1952 (Revised)

EMPLOYEES’ PENSION SCHEME [ PARAGRAPH 20(4)]


(To be filled in by EPFO)
Establishment Status Group Code
Name and Address of the Establishment
Code No. H R / 0 0 0 0 0

Statutory Rate of Contribution 1 2 %

Currency period from 0 1 0 4 2 0 1 0 TO 3 1 0 3 2 0 1 1 Statement of contributions for the Month of 0 9 2 0 1 0

Wages on Amount of Contribution Amount Amount of


Amount of Contribution
which Remitted of Admin Admin Date of Remittance
Particulars
Contribution is Received Payable by
Worker's Employer's Charges Charges (enclose triplicate copies of Challan)
payable from the the Due Remitted
Share Share
Wroker Employer
1 2 3 4 5 6 D D M M Y Y Y Y

EPF A/c No.: - 1 - - - - - - - 2 0 1 0

Pension Fund A/c No.: - 10 - - - NIL 0 0 0 0 2 0 1 0


NIL NIL
D. L. I. A/c No.: - 21 - - - - - 0 0 0 0 2 0 1 0

Total No. of Employees


Name & Address of State Bank of India
a. Contract - the Bank in which
the Amount is
b. Rest - Remitted Rs. -
c. Total -

Details of Subscribers E.P.F. Pension Fund E.D.L.I.


No. of Subscribers as per last month - - -
No. of New Subscribers (Vide From 5) - - -
No. of New Subscribers left service (Vide Form 10) - - -
Signature of the Employer
(Nett.) Total Number of Subscribers - - - with official Seal

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