This document is an annual statement of contribution for an establishment to the Employees' Provident Fund Scheme and Employees Pension Scheme. It includes details of member contributions deducted from wages and remitted by the employer each month, including the employee and employer contribution amounts to the Provident Fund and Pension Fund. It also includes a reconciliation of total amounts remitted each month and certifies that individual member contribution forms are enclosed.

1. 1 of 5
(FOR UNEXEMPTED ESTABLISHMENTS' ONLY)
FORM 6A
THE EMPLOYEES' PROVIDENT FUND SCHEME, 1952
(PARAGRAPH 43)
AND
THE EMPLOYEES PENSION SCHEME, 1995
[PARAGRAPH 20 (4)]
Annual statement of contribution for the Currency period from 1
st
April ……….. to 31
st
March ……….
Name & Address of the Establishment............................................................................................ Satutory rate of contribution..................................................................……………………………………....
Code No. of the Establishment ............................................................................................... ……No. of members voluntarily contributing at a higher rate ...................…………………………………..........…
Employer's Contribution w.e.f. 16-11-1995Sl. No.
(1)
Account
No.
(2)
Name of member
(in block letters)
(3)
Wages, retaining
allowance
(if any) & DA including
cash value of food
concession paid during the
currency period.
(4)
Amount of worker's
contributions deducted
from the wages
EPF
(5)
EPF difference between
10% & 8
1
/3 %
(6)
Pension Fund
10% & 81
/3 %
(7)
Refund of
Advance
(8)
Rate of higher
voluntary
contribution
(if any)
(9)
Remarks
(10)

2. 2 of 5

3. 3 of 5
Reconciliation of Remittances
Signature of Employer (with office seal)
NOTE:- (1) The names of all members, including those who had left service during the currency period, should be included in this statement. Where the Form 3-A in respect of such members had left
service, the fact should be stated against the members in the 'Remarks' column.
(2) In case of substantial variation in the wages/contribution of any members as compared to those shown in previous months statement, the reason should be explained adequately in the
'Remarks' column.
(3) In respect of those members who have not opted for Pension Fund their entire employers contribution @ 8
1
/3% or 10% as the case may be shown under column No. 6.
Amount remitted (Admn. Charges Rs. at 0.65% of
wages)
naMº
No. Month
EPF Contributions
including refund of
advances A/c No. 1
Pension Fund
Contributions A/c No.
10
DLI Contribution
A/c No. 21
Adm. Charges
A/c No. 21
EDLI ADM.
Charges 0.01%
A/c No. 22
Cols. 5, 6, 7 Rs.
Aggregate ( )
contributions ( )
1. Mar. Paid in Apr. Rs. Rs. Rs. Rs. Rs. Rs.
2. May Rs. Rs. Rs. Rs. Rs. Rs.
3. June Rs. Rs. Rs. Rs. Rs. Rs.
4. July Rs. Rs. Rs. Rs. Rs. Rs.
5. August Rs. Rs. Rs. Rs. Rs. Rs.
6. September Rs. Rs. Rs. Rs. Rs. Rs.
7. October Rs. Rs. Rs. Rs. Rs. Rs.
8. November Rs. Rs. Rs. Rs. Rs. Rs.
9. December Rs. Rs. Rs. Rs. Rs. Rs.
10. January Rs. Rs. Rs. Rs. Rs. Rs.
11. February Rs. Rs. Rs. Rs. Rs. Rs.
12.
Feb. Paid in Mar.
Rs. Rs. Rs. Rs. Rs. Rs.
13. Arrear if any Rs. Rs. Rs. Rs. Rs. Rs.
14.
Total Rs. Rs. Rs. Rs. Rs. Rs.
I. Total number of contribution cards
enclosed (Form 3A.........................)
II. Certified that form 3A duly
completed, of all the members listed
in this statement are enclosed. The
F3A already sent during the course
of the currency period for the final
settlement of the concerned
member's account vide 'Remarks'
furnished against the names of the
respective members above, are also
enclosed.