FORM 5 THE EMPLOYEE'S PROVIDENT FUND SCHEME. 1952 (Paragraph (2) (a)] AND THE EMPLOYEES PENSION SCHEME 1995 (Para-20 (4)] Return of Emoloyees qualifying far membership of the Employees Provident Fund, Employees Pension Fund & Emolovees’ Oeposit Linked Insurance Fund for the fret time duting the morth of... (To be sant ta the Commissioner with Form 2 (E*F & E 8) Name & Address of Factory Este. Code No of Factow/Establshment ue Name of the Employee Father's Name or husbard’s: Date of Bate of Joining ‘Total period of previous service | Remar sina | Acccun Tables cesta) nem nave aad wen Sew” | soe | hebsnd? | seot Beane icine he ‘Mite psies 1 2 2 ‘ |_s ‘ 2 f 3 Dee ‘Stamp of the Factory/Estt. Signature of the Employer or other authorised officer of the Factory/EstablishmentFORM 10 ‘THE EMPLOYEES’ PROVIDENT FUNDS SCHEME, 1952 [Paragraph 36 (2) (a) & (b)] EMPLOYEES’ PENSION SCHEME, 1995 [Paragraph 20 (2)] Return of the members leaving service during the month of... Name and adcress of the Factory Estt.. Fathars nae ot aban SL No, count Ne tne of member hoc we ee a ren + - s z _ = 8 — | Signature ofthe empoyet or omer Paw authorised officer * Please state whether the member is (a) according to para (69. (1) or (b) of the scneme (b) leaving India for permanent sottlémont abroad (c) retrenchment (é) Pt & total disabloment due to employment injury (e) discharged ({) resigning from or leaving sorvice (g) taking up employment elsewhere (Tho Name & Address of the Emplovers should be stated) (h) death (i) attained the age of 68 years. “Certified that the member mentioned at serial No... Shui Daid/nat naid retrenchment compensation of Ra under the industial Dispute Act. 1947", ‘Stamp of the Factory/Estt. Signatur of the Employer