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    Form A

    Uploaded by

    Chandra Chandu Arya
    This document outlines a form for employers to submit employee and employer contribution details for their establishment's employees for the periods ending June 30th and December 31st. The form requires the employer to provide their establishment name and address, class of establishment, total employee count, contribution amounts from employees and employers separately at the specified rates, the total contribution, and payment details. The employer must sign the completed form.

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    Form A

    Uploaded by

    Chandra Chandu Arya
    7 views1 page
    This document outlines a form for employers to submit employee and employer contribution details for their establishment's employees for the periods ending June 30th and December 31st. The form requires the employer to provide their establishment name and address, class of establishment, total employee count, contribution amounts from employees and employers separately at the specified rates, the total contribution, and payment details. The employer must sign the completed form.

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    FORM A

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    This document outlines a form for employers to submit employee and employer contribution details for their establishment's employees for the periods ending June 30th and December 31st. The form requires the employer to provide their establishment name and address, class of establishment, total employee count, contribution amounts from employees and employers separately at the specified rates, the total contribution, and payment details. The employer must sign the completed form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    7 views1 page

    Form A

    Uploaded by

    Chandra Chandu Arya
    This document outlines a form for employers to submit employee and employer contribution details for their establishment's employees for the periods ending June 30th and December 31st. The form requires the employer to provide their establishment name and address, class of establishment, total employee count, contribution amounts from employees and employers separately at the specified rates, the total contribution, and payment details. The employer must sign the completed form.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    Download as docx, pdf, or txt
    of 1

    FORM A

    [See Rule 3(4)]
    STATEMENT OF EMPLOYEE’S AND EMPLOYER’S CONTRIBUTION FOR THE SIX MONTHS ENDING
    ON THE 30TH JUNE AND THE 31ST DECEMBER, RESPECTIVELY
    ANNEXURE

    1. Name of the establishment

    2. Name of the employer


    3. Class of establishments (i.e. whether a factory of motor omni bus service, a shop,
    commercial establishment, residential hotel, restaurant, eating house, theatre or other
    place of public amusement or entertainment).
    4. Address of the establishment
    5. Total number of employees whose names stands on the establishment register on the
    30th June/the 31st December.
    6. (a) Employees' contribution at the rate of Rs……………………….
    (b) Employers' contribution at the rate of Rs. ………………………Per employee,
    7. Total of sub-entries (a) and (b) of entry 6.
    8. Whether the contribution has already been paid to the Welfare Commissioner, if so,
    whether by cheque, money order or cash and details thereof.

    Signature of the employer

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