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Detail Of Employees Resign During The Month - Exempted Establishment ( Form 3 [IF] )

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  • 1. 1062988.xls FORM NO.- 3 (IF) (FOR EXEMPTED ESTABLISHMENT ONLY) THE EMPLOYEES' DEPOSIT LINKED INSURANCE SCHEME, 1976 (PARAGRAPH-10) RETURN OF THE MEMBERS OF INSURANCE FUND LEAVING SERVICE DURING THE MONTH OF NAME & ADDRESS OF ESTABLISHMENT : CODE NO. OF THE ESTABLISHMENT : SL. ACCOUNT NAME OF THE MEMBER FATHER'S NAME OR DATE OF REASON FOR REMARKS NO. NO (IN BLOCK CAPITALS) HUSBAND'S NAME ( IN CASE LEAVING LEAVING OF MARRIED WOMAN ) SERVICE SERVICE (1) (2) (3) (4) (5) (6) (7) Date: SIGNATURE OF THE EMPLOYER STAMP OF THE ESTABLISHMENT NOTE : In case of death of a member, while in service, furnish :- (a) Date of payment of PF dues. (b) Amount Paid. (c) To Whom Paid? ( In shares, if any ). LEFT EDLI_3_IF_ _EKL_ Page 1