Documents verification Checklist for the State of

-------------------Vendor Code

Vendor Name

PF Code No.

ESIC Code
No.

Work Orders
issued from (Co
Code):

Work Order
No.s

Invoice No. &

Value
Compliance
documents for
the month of

Location
NLD/Intra
City

Service Period
(From & To
dates)
S.NO.

COMPLIANCE

REMARK

A) Initial / One Time Documents

Indemnity bond as per the approved draft with WO No.
mentioned therein on Non Judicial stamp paper of Rs.200/duly notarised has been provided and whether the same was
received before commencement of work
Agreement Copy
Copy of WO & Service Invoice
Agreement Copy
Copy of Labour license or declaration in lieu of Labour
License as per the approved draft duly signed by concerned
CPH is received (As per Annexure A below)
Form V and CLRA RC copy not received
Whether Labour License is valid during the compliance
period being verified by this checklist. If not, whether
Labour License renewal has been applied for or Closure
notice has been given to Labour Authorities.
Form V and CLRA RC copy not received
While Applying for License, will submit
Copy of Form VIA, if applicable
the same
Undertaking as per the approved draft for not deploying
Inter State Migrant Workmen is enclosed (As per Annexure
B below)
Declaration Attached
Whether PF Code draft letter is taken before commencement
of work
Available with you
Whether ESIC code allotment letter is taken before
commencement of work (Pls specify if not applicable)
Available with you
`a Whether the vendor has taken an Employee Co-ordinate with Credit Note Team
Compensation Policy
Whether the policy is valid during the compliance
period being verified. If not a declaration for deduction
b towards non-compliances is obtained from the vendor
Co-ordinate with Credit Note Team
Whether the Workmens compensation policy covers the
c wage and skills of the employees employed correctly
Co-ordinate with Credit Note Team

10

Copy of BOCW registration, if applicable.

1
2

4
5

6
7
8

N/A

11

4
5

Whether One Time documents such as Indemnity Bond, PF

Code Draft letter, ESIC Coverage letter etc, Declaration for
non-employment of Inter State Migrant Workmen, Child
Labour etc. are received before commencement of work

B) Monthly Documents
Attendance Register: Whether duly certified by the
Vendor or its Authorised representative.
Wage register: Whether duly certified by EIC of HFCL
as witness to payment besides a declaration on the wage
register stating that all workmen deployed thru the
vendor have been covered for payment. The wages paid
should be as per the latest Central Minimum Wage
Circular & No. of days put in by the workmen.
Provident Fund:
Whether ECR copy is enclosed and the
contributions remitted tally with Wage
a Sheet deductions
Electronic Challan is enclosed and all
dues including allied dues are paid (In
case A/c No. XXI is zero, EDLI exemption
related compliances have to be obtained,
b as detailed in Annexure C, below)
CRN is obtained which confirms that
c payment has been remitted
Whether the EPF- TRRN no. shown on the
d challan is verified online for payment
In case EPF is not deducted, Form No.11
is enclosed for Non-EPF members as per
e the sample shown in Annexure__________
Employees State Insurance Act
Whether ESI is applicable to the area or nature of
a job being carried out
If applicable, whether the same is deducted from
b Wages @1.75% of the Gross Salary
Whether electronic challan is obtained and the
payment is duly acknowledged by State Bank of
c India
Whether Monthly Contribution report has been
obtained and the deductions in wage sheets tally
d with it
Whether online remittances based in the IP No.
shown has been checked in ESIC IP Portal on
e random basis for at least 10% cases
Workmens Compensation Act
Whether Employee Compensation Policy has been
taken for the Skill set of employees as shown in
a the muster
Whether Employee Compensation Policy is in force
during the compliance period. If not, consent of the
vendor has been obtained for proportionate
b deduction from his payments.
c Whether the wages specified in the Policy are not
understated to reduce the premium and the
employees are covered as per the wages drawn by

Kindly ask client for the declaration

draft and have it done at your end

Available with you

Available with you

Yes.

Yes.
Yes.
Yes.

Deducted for all employees

7
8
9

them as per wages sheet

In case ESI compliances has been given, a policy
has been taken in respect of the employees who are
d not ESI members
Profession Tax as per rates below (On Annual Income)
Up to 1,50000/Nil
1,50001 - 1,80,000/1500/1,80,001 and above
2500/Labour Welfare Fund as per slabs below:
Employee Cont Rs. 10/Employer Cont Rs. 30/-(Minimum Rs. 1500)
(Deduction in June and December)
Cess Receipt under BOCW Act, wherever applicable
Low labour component certificate duly signed by the
concerned is enclosed (If applicable)
Remarks/ Specific observations of IRC, if any

Have verified all the compliance documents and any discrepancies observed have been taken up
with the vendor and thereafter specifically noted in the Remarks and according to me, there are
no other shortfalls and I take full responsibility for any other observations which Central
compliance Cell may notify after their review.
State IRCs Name: _________________________________
Signature:

__________________________________
FOR USE OF CENTRAL COMPLIANCE CELL

Remarks, Specific observations, if any

Have verified the compliance documents and the remarks provided against each
of the compliances above and there are no observations other than those
specified above. I have also verified online as regards the EPF remittances in
respect of the TRRN No. related to the compliance period and also verified IP
Portal on random basis for remittances of ESI (If applicable) in respect of 5%
employees.
I am satisfied with the compliance documents and the remarks given by State
IRC and recommend clearance of compliance documents. I take the full
responsibility of any audit observations hereafter other than those specified
above.

Name of the Central Compliance Cell co-ordinator :

___________________________________
Signature: _______________________________________

Annexure A
DECLARATION BY VENDOR FOR NON-APPLICABILITY OF LABOUR LICENSE
On HFCLs Letterhead bearing Circle office address

Subject: Certification

This is to inform and certify that M/s_______will not be deploying 20 or more contract
workmen/labour on any day during the execution of the contract work on allotted site id
no______ allotted vide WO No.___________.

However, in future, if ever the no. of contract workmen to be deployed exceeds the stipulated
statutory no. of 20 or more workmen, the vendor will immediately apply for labour license
with the concerned Licensing authority under CL(R&A) Act, 1970/Central Rules, 1971 and
obtain labour license for the required capacity.

Thanking You

(Circle Execution Head)

Annexure B

DECLARATION FOR NON-EMPLOYMENT OF CHILD LABOUR

AND INTER STATE MIGRANT WORKERS

To,
Himachal Futuristic Communications Limited
77B, Lower Ground Floor,
IFFCO Road, Sector-18, Gurgaon,
Haryana-122015, India

I/We/M/s _____________________, hereby declare that we will not engage any child labour
or Inter State Migrant Workmen on any day during the period of contract in the establishment
of M/s Himachal Futuristic Communications Ltd for execution of the work awarded to us vide
WO No. ___________________________.

We hereby indemnify M/s Himachal Futuristic Communications Ltd against any legal hassles
arising due to lapses on our part unde Inter State Migrant Workmen (Regulation of
Employment and Conditions of Services) Act, 1979.
Thanking You,

(Authorized Signatory)

Date

Place

Annexure C

DOCUMENTS TO BE OBTAINED IN CASE OF EDLI EXEMPTION

Certain establishments apply for EDLI exemption u/s 17 (2A) of the EPF Act and obtain a
policy in lieu of EDLI. This results into their remittance A/c No. 21 is zero and A/c No. 22 @
0.005% as EDLI Inspection Charges. EDLI exemption is valid for 3 years only and a renewal
is to be applied 6 months prior to the expiry of exemption.
We as PE need to obtain the following documents: (Copies only)
1. Exemption order notified by the Central Govt. in its official Gazette (For 3 years only)
OR
2. Relaxation order issued by concerned RPFC u/p 28(7) OR
3. Application for exemption made to concerned RPFC
4. Certificate of coverage issued by Insurance Company indicating the benefits payable
and the policy is in force within the compliance period. The current flat coverage is
Rs.132000/5. Form No. 7IF filed with concerned RPFC- Monthly

Form 11- SAMPLE COPY

Employee
Code____

Form 11

THE EMPLOYEES PROVIDENT FUNDS SCHEME, 1952 (Paragraph 34)

AND
THE EMPLOYEES PENSION SCHEME, 1995 (Paragraph 24)
Declaration by a person taking up employment in an establishment in which
the Employees Provident Funds & Employees Pension Scheme enforce

Vijay T Shukla

Son/

(Name of Employee)

of*Sh.

wife/

daughter Tribhuwan

do hereby solemnly declare that :-

(a)

I was employed in ---------(Name and Full Address of the

M/s
and left service on
----------

immediate previous employer)

prior to that, I was employed

in
to
----------

(Date of leaving with immediate previous employer)

from

----------

----------

(Name and Full Address of the second last employer, if any)

(Date of joining & leaving with second last employer, if any)

(b)

I was member of

---------(Name of PF Trust / Address of PF Office of immediate previous employer )

Provident Fund and also/but not* of the Pension Fund

fro
m

----------

to

----------

(Date of joining & leaving with immediate previous employer) .

and my account number (s) was/were

---------(PF No. with Establishment Code of immediate previous employer)

(c)X

I have / have not* withdrawn the amount of my Provident Fund/Pension Fund.

(d)X

I have / have not*drawn any superannuation benefits in respect of my past service from any employer.

(e)

I have / have never* been a member of any Provident Fund and/or Pension Fund.

(f)X

I am drawing / not drawing* Pension under EPS 95.

(g)X

I am a holder / not holder* of scheme Certificate.

(h)X

Scheme certificate surrendered / not surrendered*.

*Strike out whichever is not applicable.

Date

23-04-2012
(Date of joining of employee)

Vijay T Shukla

Shri/Smt.
in M/s

(Name of Employee)

HFCL
(Name of the present employer )

P.F. Account Number

Date

23-04-12

is
as

VTS
Signature or left hand thumb
impression of the employee
Dy Mgr
appointed

with effect from

(PF No. with Estt. Code of present employer)

HFCL

(Designation with Co.)

23-04-12
(Date of appointment)

(Date of joining of employee)

Signature of the Employer/Manager or Other

Authorised Officer with Office Seal