FORM 1 (See paragraph 39A) Monthly return to be submitted by the exempted establishments/class of establishments/board of trustees 1. Details of establishment : | .................................................................. | (a) Name of the establishment with full address : | .................................................................. | (b) Code No. allotted by the employees provident fund organisation : | .................................................................. | 2. Details of employees (include all branches/units, etc.) : | | | | | | | | | | | | | | (a) No. of employees as at the end of previous month : | | | | | | | | | | | | | | (b) No. of employees who joined during the month : | | | | | | | | | | | | | | (c) No. of employees who left service during the month : | | | | | | | | | | | | | | (d) No. of employees as at the end of the month : | | | | | | | (a) + (b) – (c) | | | | | | | (e) Out of (d) above, No. of excluded employees : | | | | | | | (f) No. of pension fund members as at the end of the month Please furnish the above mentioned details unit-wise situated at different places. | | | | | | | Attach separate sheet, if necessary : | | | | | | |
3. Constitution of board of trustees : | | | | | | | | | | | | | | | | | | | | | | | | | | | | (a) Date on which the present board was constituted : | | | | | | | | | | | | | | | D | D | | M | M | | Y | Y | Y | Y | | | | (b) Its term : Years | | | | | | | | | | | | | | | | | | | | | | | | | | | | (c) Total number of trustees : | | | | | | | | | | | | | | | | | | | | | | | | | | | | (i) Employees’ representatives : | | | | | | | | | | | | | | | | | | | | | | | | | | | | (ii) Employer’s representatives : | | | | | | | | | | | | | |
4. Wages, contributions, etc. : | | | | | | | | | | | (a) Amount of gross wages liable to pension contribution : | Rs. | | | | | | | | | | | | | | | | | | | | | (b) Rate of contribution to pension fund | | | | % | | | | | | | | | | | | | | | | | | (c) Amount of pension contribution to be transferred for | Rs. | | | | | | | | | | the current month : | | | | | | | | | | | (d) Amount of arrears due, if any, for transfer to the board | | | | | | | | | | | of trustees at the end of the previous month : | Rs. | | | | | | | | | | | | | | | | | | | | | (e) Total of (c) & (d) : | Rs. | | | | | | | | | | | | | | | | | | | | | (f) Amount actually transferred to the board of trustees : | Rs. | | | | | | | | | | | | | | | | | | | | | (g) Balance due, if any, for transfer to the board of trustees | Rs. | | | | | | | | | | (e) - (f) : | | | | | | | | | | | | | | | | | | | | | | (h) Whether the interest payable under section 7Q of the | | | | | | | | | | | Act for the belated transfer of funds, if any, has been | | | | | | | | | | | Paid? | Yes | | No | | | | | | | | | | | | | | | | | | | (i) Amount of interest still payable at the end of the month: | Rs. | | | | | | | | | |
5. Details of pensioners | | | | | | | (a) No. of pensioners at the end of the month : | | | | | | | (i) Member (self) pensioners : | | | | | | | — Superannuation pension : | | | | | | | | | | | | | | — Early pension : | | | | | | | | | | | | | | — Disablement pension : | | | | | | | (ii) Spouse pensioners : | | | | | | | | | | | | | | — Death in service : | | | | | | | | | | | | | | — Death away from service : | | | | | | | | | | | | | | — Death as pensioner : | | | | | | | (iii) Children pensioner : | | | | | | | | | | | | | | — Normal children : | | | | | | | | | | | | | | — Disabled children : | | | | | | | | | | | | | | (life-long pension) | | | | | | | | | | | | | | (iv) Orphan pensioner : | | | | | | | | | | | | | | (v) Nominee pensioner : | | | | | | | | | | | | | | (vi) Dependent parents pensioner : | | | | | | | | | | | | | | (b) Total amount of pension paid during the month : | | | | | | |
6. Details of exit cases : | | | | | | | | | (a) No. of persons who have taken withdrawal benefit | | | | | | | | | during the month : | | | | | | | | | | | | | | | | | | (b) Amount paid during the month : | Rs. | | | | | | | | | | | | | | | | | No. of exit cases where scheme certificate has been | | | | | | | | | Issued | | | | | | | | |
7. Details of investment : | | | | | | | | | | | | | | | | | | | | | | (a) Amount lying invested in the pension fund in the | | | | | | | | | | | beginning of the month : | Rs. | | | | | | | | | | (b) Amount received during the month : | | | | | | | | | | | | | | | | | | | | | | (i) By way of contribution from the employer : | | | | | | | | | | | | | | | | | | | | | | Current month : | Rs. | | | | | | | | | | | | | | | | | | | | | Arrears, if any : | Rs. | | | | | | | | | | | | | | | | | | | | | (ii) Encashment of matured securities/deposits : | Rs. | | | | | | | | | | | | | | | | | | | | | (iii) Interest/dividend on investments : | Rs. | | | | | | | | | | | | | | | | | | | | | (iv) Other transfer-in-cases : | Rs. | | | | | | | | | | | | | | | | | | | | | (v) Damages, if any : | Rs. | | | | | | | | | | | | | | | | | | | | | (vi) Interest on belated payments, if any : | Rs. | | | | | | | | | | | | | | | | | | | | | (vii) Miscellaneous, if any (please specify) : | Rs. | | | | | | | | | | | | | | | | | | | | | (c) Payments made during the month : | Rs. | | | | | | | | | | | | | | | | | | | | | (d) Amount invested during the month : | | | | | | | | | | | | | | | | | | | | | | Securities : | | | | | | | | | | | | | | | | | | | | | | — Central Government : | Rs. | | | | | | | | | | | | | | | | | | | | | — State Governments : | Rs. | | | | | | | | | | | | | | | | | | | | | — Others, if any : | Rs. | | | | | | | | | | | | | | | | | | | | | Deposits: | | | | | | | | | | |
| | | | | | | | | | | — Public financial institutions/banks : | Rs. | | | | | | | | | | | | | | | | | | | | | (e) Whether pattern of investment followed : | Yes | | | | | No | | | | | | | | | | | | | | | | (f) If so, classify the percentage : | | | | | | | | | | | | | | | | | | | | | | (i) Securities : | | | | | | | | | | | | | | | | | | | | | | — Central Government : | | | % | | | | | | | | | | | | | | | | | | | — State Governments : | | | % | | | | | | | | | | | | | | | | | | | — Others, if any : | | | % | | | | | | | | | | | | | | | | | | | (ii) Deposits : | | | | | | | | | | | | | | | | | | | | | | — Public financial institutions/banks : | | | % | | | | | | | | | | | | | | | | | | | (iii) Annuity purchased from LIC : | Rs. | | | | | | | | | | | | | | | | | | | | | (g) Amount lying uninvested in cash/bank : | Rs. | | | | | | | | | |
8. Mode of disbursement ü Tick one : | | | | | | — Through bank : | | | | | | — Through post offices : | | | | | | — Through LIC by purchase of annuity : | | | | | | — Others, if any (please specify) : | | |
9. Rules of establishment’s pension fund : | | Details of amendment, if any carried out during the month to make the rules at par with the statutory Pension Scheme (Employees’ Pension Scheme, 1995) | ..................................................................... | ..................................................................... | | Date: ....................... | ....................................................................... | | Signature with official seal of the employer/trustees of the board |
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