Contribution by the Employer Total interest on the amount shown in column 6.

Exempt Employers contribution not exceeding statutory limit. 8 Interest on sum in Column 6 at % but not exceeding statutory limit 9

Month and Salary year

(Contribution) Normal By employees

Of contingent nature,

Total in columns 3,4,5.

Not exempt Additions to total income 10 Remarks. plus Column 11. 12 13

Contribution Column 4+5 minus Column 8

Interest Column 7 minus Column 9.

10

11

Account closed. Date Paid to employee Lapsed to the employer or to fund Recovery by employer Name_______________ Date of joining Fund_______________ Balance brought forward July August September October November December January February March April May June Total: Adjustment on account of temporary Withdrawals account (Column 8 and 9 only). Adjustment on account of non-payable Withdrawals account Columns 10 and 11. Total carried over. If desired column 7 may be divided into sub-columns showing separately the interest on columns and columns 4 and 5 respectively. Non-payable withdrawals Account Amount July August September October November December January February March April May June Total:

Temporary withdrawal Account Advance Repayment July Balance brought Forward

Pers.No. Personnel Name

Date of joining Fund

PF Balance b/f as of 30-06-13

Mem Cont. Bank Cont. for Jul-13 Basic Salary for Jul-13

Bank Cont. not exceeding statutory limit

Non Refundable Withdrawal