40[If any person,
(a) deducts or attempts to deduct from the wages or other remuneration of a member the whole or any part of the employer's contribution; or
(b) fails or refuses to submit any return, statement or other documents required by this Scheme or submits a false return, statement or other documents, or makes a false declaration; or
(c) obstructs any Inspector or other official appointed under the Act or this Scheme in the discharge of his duties or fails to produce any record for inspection by such Inspector or other official; or
(d) is guilty of contravention of or non-compliance with any other requirements of this Scheme,
he shall be punishable with imprisonment which may extend to one year or with fine which may extend to four thousand rupees, or with both.]
Form 1(IF)
(For exempted establishments only)
THE EMPLOYEEs' DEPOSIT LINKED-INSURANCE SCHEME, 1976
(Para 10)
Code No. of the Establishment . . . . . . . . . . .
Consolidated Return of employees who are entitled and required to become members of the Insurance Fund on the date of Scheme comes into force.
Name and Address of the Establishment. . . . . . . . . . . . . Date of Coverage. . . . . . . . . . . . . . . . . .
Industry in which the Establishment is engaged. . . . . . . . Registration No. of the Estt.. . . . . . . . . . .
| Sl. No. |
Account No. as in P.F. |
Name of the Employee (in block capitals) |
Father's name or husband's name (in the case of married woman) |
Sex |
Remarks |
| 1 |
2 |
3 |
4 |
5 |
6 |
| |
|
|
|
|
|
| Date: |
Signature of the Employer or other Authorised Officer |
Station:
Note: Remarks for the missing A/c No. (i.e. those in respect of employees who had left service etc. should be given at the end).
Stamp of the Establishment
Form 2(IF)
(For exempted establishments only)
THE EMPLOYEEs' DEPOSIT-LINKED INSURANCE SCHEME, 1976
(Para 10)
Return of employees entitled for membership of Insurance Fund
Name and Address of the Establishment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
during the month. . . . . . . . . . . . . . . . . . . . . . . . . . 20. . . . . . . . . . . . . . . . . . . . . . . . . . .
Code No. of the Establishment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
| Sl. No. |
Account No. as in P.F. |
Name of the Employee (in block capitals) |
Father's name or husband's name (in the case of married woman) |
Sex |
Date of entitlement for membership |
REMARKS Previous Account No. in Provident Fund Particulars of prev. employer & the amount of accumulation |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
| |
|
|
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| |
|
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|
|
|
|
| |
|
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|
|
|
| Date: |
Signature of the Employer or other Authorised Officer of the Establishment |
Note: This form should be accompanied by certified copies of the nomination(s) and/or changes therein made by each employee under Provident Fund Rules of the Establishment.
Stamp of the Establishment
Form 3(IF)
(For exempted establishments only)
THE EMPLOYEEs' DEPOSIT-LINKED INSURANCE SCHEME, 1976
(Para 10)
Name of the members of Insurance Fund leaving service during the month of. . . . . . . . . . . . . . . 20 . . . .
Name and Address of the Establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Code No. of the Establishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
| Sl. No. |
Account No. |
Name of the Member (in block capitals) |
Father's name or husband's name (in the case of married woman) |
Date of Leaving Service |
Reason for Leaving Service |
Remarks |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
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|
|
|
|
| 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 P.F. dues.
(b) Amount paid.
(c) To amount paid? (In shares, if any).
Form 4(IF)
(For exempted establishments only)
Total No. of Employees
Contract Rest Total
THE EMPLOYEEs' DEPOSIT-LINKED INSURANCE SCHEME, 1976
(Para 10)
Monthly Statement of Contributions for the month of . . . . . . . . . . 20. . . .. . . . . Currency Period from 1st April, 20 . . . . . . . . . .to 31-03-200. . . . . . . . . .
Total No. of members. . . . . . . . . .
Name & Address of the Establishment . . . . . . . . . . . . . . . . . . . Statutory Rate of Contribution 0.5%
Code No. of the Establishment. . . . . . . . . .
| Wages on which contributions are Payable |
Amount of employer's share of contribution due @0.5% of the amount of wages shown in col. 1 |
Amount of administrative charges due at 0.01% of the amount of wages shown in col. 1 |
Employer's share of contribution remitted in A/c No. 21 |
Amount of administrative charges remitted in A/c No. 22 |
Date of remittance |
Name & location of the Bank in which remitted of No. & date of the cheque/draft sent to Regional Office |
Whether the triplicate challan receipt is enclosed, if not state reasons |
Re-marks |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
(9) |
| |
|
|
|
|
|
|
|
|
| Date: |
Signature of the Employer (with office seal) |
No. as per last month's return (+) No. of new members vide Form 2(IF)(-) No. of members left service vide Form 3(IF).
*Net Total *This should tally with the figures given at the top right hand corner of the form.
Note: (1) If there is any substantial variation between the wages and amount of contribution shown above and those shown to the last month's return, suitable explanation should be given in the Remark's column.
(2) If any arrears of contribution of damages are included in the figures under column 4, suitable details indicating the circumstances, Account No. of members and the period involved should be furnished in the Remark's column or on the reverse.
Regn. No.
Form 5(IF)
THE EMPLOYEEs' DEPOSIT-LINKED INSURANCE SCHEME, 1976
(Form to be used by a nominee/Legal heir of the deceased or guardian of the minor nominee(s)/Legal heir under Paragraph 23 of this Scheme)
(Note: Read the instruction carefully before completing this form)
(Through the employer under whom the deceased was last employed)
I, being a nominee/Legal heir/guardian of minor nominee(s) or minor heir(s) of the deceased employee, apply for the payment of the Assurance Benefit under the Employees Deposit-Linked Insurance Scheme, 1976.
(FOR USE BY THE NOMINEE/LEGAL HEIR, OTHER MINORS)
| Name and address of the applicant |
Sex |
Age or year of birth |
Marital Status |
Relationship with the deceased |
Remarks |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
| |
|
|
|
|
|
FOR USE IN RESPECT OF MINOR NOMINEE(S)/HEIR(S)
| Name and address of the applicant |
Sex |
Age or year of birth |
Name of minor nominee/heir(s) |
Sex |
Age or year of birth |
Relationship of the guardian with the minor nominee/heir(s) |
Remarks |
| (1) |
(2) |
(3) |
(4) |
(5) |
(6) |
(7) |
(8) |
| |
|
|
|
|
|
|
|
2. The particulars in respect of the deceased member are furnished below.
(a) Name of the deceased. . . . . . . . . . . . . . . . . . . . . . . . . .
(b) Father's name/or Husband's name (in the case of married women)
(c) Date of Death . . . . . . . . . . . . . . . .
(d) Last employed in . . . . . . . . . . . . . . . .
(e) Account No. in Provident Fund/Insurance Fund . . . . . . . . . . . . . . . .
3. The particulars of the Savings Bank Account into which the amount is to be deposited.
Paragraph 24(3) of the Employees' Deposit-Linked Insurance Scheme, 1976
(a) Name and address of the claimant
(b) Name and full address of the Bank specified in the First Schedule to the Banking Companies (Acquisition and Transfer of Undertaking Act, 1980).
(c) Savings Bank Account No. of claimant.
4. I declare that above particulars are true to the best of my knowledge.
| Date: |
Signature of the left/right hand thumbimpression of Shri/Smt./Km. (the applicant) (Left thumbimpression in the case of illiterate male applicants and right thumb impression in the case of illiterate female applicants). |
Advance Stamped Receipt
| Received a sum of Rs*. . . . . . . . . . . . (Rupees*. . . . . . . . . . . .) from Regional Provident Fund Commissioner/Officer-in-Charge of Sub-Regional Office. . . . . . . . . . . . by deposit in my Savings Bank |
| Account towards the Employees' Deposit-Linked Insurance Benefit. Date. . . . . . . . . . . . 20. |
Affix Rupee 1 Revenue stamps |
| *The space should be left blank which shall be filled in by RPFC/Officer-in-Charge of S.R.O. |
|
| |
Signature or right hand thumb- impression of the claimant |
______________________________________________________________________________________
Certified that the CLAIMANT signed/thumb impressed before me.
| Enclosure: |
Signature of the Authorised Officer |
| Date. . . . . . . . . . . . 20. |
| |
Designation: Stamp of the Factory/Estt. |
Note: The employer of unexempted establishments should fill in the column 2 and 3 only and the employer of exempted establishments should in all the column.
Balance in Provident Fund at the end of the month preceding the 36 months immediately preceding the death of member.
TO BE FILLED IN BY EMPLOYER ON DUE BASIS
| Month |
Both shares of contribution |
Refund of withdrawal |
Interest |
Withdrawal |
Progressive Balance |
| 1 |
|
|
|
|
|
| 2 |
|
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|
| 3 |
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| 4 |
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| 5 |
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| 6 |
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| 7 |
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| 8 |
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| 9 |
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| 10 |
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| 11 |
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| 12 |
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| 13 |
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| 14 |
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| 15 |
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| 16 |
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| 17 |
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| 18 |
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| 19 |
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| 20 |
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| 21 |
|
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| 22 |
|
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| 23 |
|
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|
| 24 |
|
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| 25 |
|
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| 26 |
|
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| 27 |
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| 28 |
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| 29 |
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| 30 |
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| 31 |
|
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| 32 |
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| 33 |
|
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| 34 |
|
|
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|
|
| 35 |
|
|
|
|
|
| 36 |
|
|
|
|
|
| Total of 36 months Provident Fund |
|
| Balance Rs. . . . . . . . . . . . |
Average Balance Rs. . . . . . . . . . . . . . . . . |
CERTIFICATE
(1) Certified that the particulars furnished above are correct.
(2) Certified that the member died on . . . . . . . . . . .while in service.
(3) Certified that the Provident Fund accumulations of the deceased employee, late Shri/Smt/Km .. . . . . . . . . . A/c No. . . . . . . . . . .were paid to Shri/Smt/Km
(i) . . . . . . . . . .
(ii) . . . . . . . . . .
(iii) . . . . . . . . . .
(The employer of exempted establishment shall send an attested copy of nomination of the deceased employee)
| Date: |
|
| |
Signature of the employer (Name and designation with official seal) |
______________________________________________________________________________________
(FOR THE USE OF COMMISSIONER's OFFICE)
| Entered in F-21-A/9 (Revised)/IFI/Withdrawal Register. |
|
| Clerk |
Head Clerk |
______________________________________________________________________________________
| (Under Rs.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
|
| P.I. No. . . . . . . . . . . |
Account No. . . . . . . . . . . |
| Section. . . . . . . . . . |
|
Passed for payment for Rs . . . . . . . . . . . . . . . . . . . .) and the amount may be remitted for credit to the Savings Bank Account No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . in respect of Shri/Smt/Kumari . . . . . . . . . .. . . . . . . . . . maintained at . . . . . . . . . . . . . . . . . . . . (Banks).
Account Officer
Date:
______________________________________________________________________________________
Paid by inclusion in Cheque No.
| Clerk |
Head Clerk |
Assistant Provident Fund Commissioner or Regional Provident Fund Commissioner |
Form 1 41[* * *]
Form 2 42[* * *]
Form 3 43[* * *]
EMPLOYEEs' DEPOSIT-LINKED INSURANCE ACCOUNT SCHEDULES
SCHEDULE NO. I
Sundry Creditors:
1. Excess credit in A/c No. 21
2. Excess credit in A/c No. 25
3. Excess credit in R.B.I. A/c
4. Excess credit in A/c No. 22
5. Excess credit in A/c No. 24
Balance as on 31st March:
SCHEDULE NO. II
Investment in securities:
Balance as per last Balance Sheet
Less:
Securities redeemed during the year
Balance as on 31st March:
SCHEDULE NO. III
Amount deposited in Public A/c
Balance as per last Balance Sheet
1. Deposits made during the year
2. Government share of contribution for
3. Government share of arrears up to
4. Interest on balance in Public Account
Balance as on 31st March:
SCHEDULE NO. IV
Amount invested
Balance as per last Balance Sheet
Add:
Amount deposited during the year
Less:
Amount redeemed during the year:
Balance as on 31st March:
SCHEDULE NO. V
Amount due from EPF Admn. A/c
(a) Transaction in A/c No. 24
Balance as per last Balance Sheet
Add:
During the year
Less:
Amount received back
Balance as on 31st March:
Transaction in regard to Account No. 22
(b) Amount transferred to EPF Account No. 2
Balance as on 31st March: (a) (b)
SCHEDULE NO. VI
Cash Book Balance:
1. Account No. 21
2. Account No. 25
3. Account No. 22
4. Account No. 24
Balance as on 31st March:
SCHEDULE NO. VII
Remittance in Transit:
1. From A/c No. 21 to 25
2. From RBI A/c to A/c No. 25
3. From A/c No. 22 to 24
Balance as on 31st March:
SCHEDULE NO. VIII
Sundry Debits
1. Account No. 21
2. Account No. 25
3. Account No. 22
4. Account No. 24
Balance as on 31st March:]
EMPLOYEEs' FAMILY PENSION CONTRIBUTION @ 11/6;%
of the total wages paid to the subscriber during the month
| Wages |
Contribution |
Wages |
Contribution |
| Rs |
Rs |
Rs |
Rs |
| 0 42 |
NIL |
2529 2613 |
30 |
| 43 128 |
1 |
2614 2699 |
31 |
| 129 213 |
2 |
2700 2785 |
32 |
| 214 299 |
3 |
2786 2870 |
33 |
| 300 385 |
4 |
2871 2956 |
34 |
| 386 470 |
5 |
2957 3042 |
35 |
| 471 556 |
6 |
3043 3128 |
36 |
| 557 642 |
7 |
3129 3213 |
37 |
| 643 728 |
8 |
3214 3299 |
38 |
| 729 813 |
9 |
3300 3385 |
39 |
| 814 899 |
10 |
3386 3470 |
40 |
| 900 985 |
11 |
3471 3556 |
41 |
| 986 1070 |
12 |
3557 3642 |
42 |
| 1071 1156 |
13 |
3643 3728 |
43 |
| 1157 1242 |
14 |
3729 3813 |
44 |
| 1243 1328 |
15 |
3814 3899 |
45 |
| 1329 1413 |
16 |
3900 3985 |
46 |
| 1414 1499 |
17 |
3986 4070 |
47 |
| 1500 1585 |
18 |
4071 4156 |
48 |
| 1586 1670 |
19 |
4157 4242 |
49 |
| 1671 1756 |
20 |
4243 4328 |
50 |
| 1757 1842 |
21 |
4329 4413 |
51 |
| 1843 1928 |
22 |
4414 4499 |
52 |
| 1929 2013 |
23 |
4500 4585 |
53 |
| 2014 2099 |
24 |
4586 4670 |
54 |
| 2100 2185 |
25 |
4671 4756 |
55 |
| 2186 2270 |
26 |
4757 4842 |
56 |
| 2271 2356 |
27 |
4843 4928 |
57 |
| 2357 2442 |
28 |
4929 5000 |
58 |
| 2443 2528 |
29 |
|
|
EMPLOYEEs' PROVIDENT FUND @ 0.65%
Administrative Charges
| Wages |
Contribution |
Wages |
Contribution |
| 0 11 |
0.05 |
304 311 |
2.00 |
| 12 19 |
0.10 |
312 319 |
2.05 |
| 20 27 |
0.15 |
320 326 |
2.10 |
| 28 35 |
0.20 |
327 334 |
2.15 |
| 36 43 |
0.25 |
335 342 |
2.20 |
| 44 50 |
0.30 |
343 349 |
2.25 |
| 51 58 |
0.35 |
350 357 |
2.30 |
| 59 66 |
0.40 |
358 365 |
2.35 |
| 67 73 |
0.45 |
366 373 |
2.40 |
| 74 81 |
0.50 |
374 380 |
2.45 |
| 82 89 |
0.55 |
381 388 |
2.50 |
| 90 96 |
0.60 |
389 396 |
2.55 |
| 97 104 |
0.65 |
397 403 |
2.60 |
| 105 112 |
0.70 |
404 411 |
2.65 |
| 113 119 |
0.75 |
412 419 |
2.70 |
| 120 127 |
0.80 |
420 426 |
2.75 |
| 128 135 |
0.85 |
427 434 |
2.80 |
| 136 143 |
0.90 |
435 442 |
2.85 |
| 144 150 |
0.95 |
443 449 |
2.90 |
| 151 157 |
1.00 |
450 457 |
2.95 |
| 158 164 |
1.05 |
458 465 |
3.00 |
| 165 173 |
1.10 |
466 473 |
3.05 |
| 174 180 |
1.15 |
474 480 |
3.10 |
| 181 188 |
1.20 |
481 488 |
3.15 |
| 189 196 |
1.25 |
489 496 |
3.20 |
| 197 203 |
1.30 |
497 503 |
3.25 |
| 204 211 |
1.35 |
504 511 |
3.30 |
| 212 219 |
1.40 |
512 519 |
3.35 |
| 220 226 |
1.45 |
520 526 |
3.40 |
| 227 234 |
1.50 |
527 534 |
3.45 |
| 235 242 |
1.55 |
535 542 |
3.50 |
| 243 249 |
1.60 |
543 549 |
3.55 |
| 250 257 |
1.65 |
550 557 |
3.60 |
| 258 265 |
1.70 |
558 565 |
3.65 |
| 266 273 |
1.75 |
566 573 |
3.70 |
| 274 280 |
1.80 |
574 580 |
3.75 |
| 281 288 |
1.85 |
581 588 |
3.80 |
| 289 296 |
1.90 |
589 596 |
3.85 |
| 297 303 |
1.95 |
597 603 |
3.90 |
| 604 611 |
3.95 |
874 880 |
5.70 |
| 612 619 |
4.00 |
881 888 |
5.75 |
| 620 626 |
4.05 |
889 896 |
5.80 |
| 627 634 |
4.10 |
897 903 |
5.85 |
| 635 642 |
4.15 |
904 911 |
5.90 |
| 643 649 |
4.20 |
912 919 |
5.95 |
| 650 657 |
4.25 |
920 926 |
6.00 |
| 658 665 |
4.30 |
927 934 |
6.05 |
| 666 673 |
4.35 |
935 942 |
6.10 |
| 674 680 |
4.40 |
943 949 |
6.15 |
| 681 688 |
4.45 |
950 957 |
6.20 |
| 689 696 |
4.50 |
958 965 |
6.25 |
| 697 703 |
4.55 |
966 973 |
6.30 |
| 704 711 |
4.60 |
974 980 |
6.35 |
| 712 719 |
4.65 |
981 988 |
6.40 |
| 720 726 |
4.70 |
989 996 |
6.45 |
| 727 734 |
4.75 |
997 1000 |
6.50 |
| 735 742 |
4.80 |
|
| 743 749 |
4.85 |
1000 |
6.50 |
| 750 757 |
4.90 |
2000 |
13.00 |
| 758 765 |
4.95 |
5000 |
32.50 |
| 766 773 |
5.00 |
10,000 |
65.00 |
| 774 780 |
5.05 |
50,000 |
325.00 |
| 781 788 |
5.10 |
1,00,000 |
650.00 |
| 789 796 |
5.15 |
|
|
| 797 803 |
5.20 |
|
|
| 804 811 |
5.25 |
|
|
| 812 819 |
5.30 |
|
|
| 820 826 |
5.35 |
|
|
| 827 834 |
5.40 |
|
|
| 835 842 |
5.45 |
|
Illustration |
| 843 849 |
5.50 |
|
2509 |
| 850 857 |
5.55 |
|
2000 13.00 |
| 858 865 |
5.60 |
|
509 3.30 |
| 866 873 |
5.65 |
|
16.30 |
EMPLOYEEs' DEPOSIT-LINKED INSURANCE CONTRIBUTION
@ 0.50% of the Total Wages
| 0 99 |
NIL |
|
7900 8099 |
40 |
| 100 299 |
1 |
|
8100 8299 |
41 |
| 300 499 |
2 |
|
8300 8499 |
42 |
| 500 699 |
3 |
|
8500 8699 |
43 |
| 700 899 |
4 |
|
8700 8899 |
44 |
| 900 1099 |
5 |
|
8900 9099 |
45 |
| 1100 1299 |
6 |
|
9100 9299 |
46 |
| 1300 1499 |
7 |
|
9300 9499 |
47 |
| 1500 1699 |
8 |
|
9500 9699 |
48 |
| 1700 1899 |
9 |
|
9700 9899 |
49 |
| 1900 2099 |
10 |
|
9900 10099 |
50 |
| 2100 2299 |
11 |
|
10100 10299 |
51 |
| 2300 2499 |
12 |
|
10300 10499 |
52 |
| 2500 2699 |
13 |
|
10500 10699 |
53 |
| 2700 2899 |
14 |
|
10700 10899 |
54 |
| 2900 3099 |
15 |
|
10900 11099 |
55 |
| 3100 3299 |
16 |
|
11100 11299 |
56 |
| 3300 3499 |
17 |
|
11300 11499 |
57 |
| 3500 3699 |
18 |
|
11500 11699 |
58 |
| 3700 3899 |
19 |
|
11700 11899 |
59 |
| 3900 4099 |
20 |
|
11900 12099 |
60 |
| 4100 4299 |
21 |
|
12100 12299 |
61 |
| 4300 4499 |
22 |
|
12300 12499 |
62 |
| 4500 4699 |
23 |
|
12500 12699 |
63 |
| 4700 4899 |
24 |
|
12700 12899 |
64 |
| 4900 5099 |
25 |
|
12900 13099 |
65 |
| 5100 5299 |
26 |
|
13100 13299 |
66 |
| 5300 5499 |
27 |
|
13300 13499 |
67 |
| 5500 5699 |
28 |
|
13500 13699 |
68 |
| 5700 5899 |
29 |
|
13700 13899 |
69 |
| 5900 6099 |
30 |
|
13900 14099 |
70 |
| 6100 6299 |
31 |
|
14100 14299 |
71 |
| 6300 6499 |
32 |
|
14300 14499 |
72 |
| 6500 6699 |
33 |
|
14500 14699 |
73 |
| 6700 6899 |
34 |
|
14700 14899 |
74 |
| 6900 7099 |
35 |
|
14900 15099 |
75 |
| 7100 7299 |
36 |
|
15100 15299 |
76 |
| 7300 7499 |
37 |
|
15300 15499 |
77 |
| 7500 7699 |
38 |
|
15500 15699 |
78 |
| 7700 7899 |
39 |
|
15700 15899 |
79 |
| 15900 16099 |
80 |
|
18100 18299 |
91 |
| 16100 16299 |
81 |
|
18300 18499 |
92 |
| 16300 16499 |
82 |
|
18500 18699 |
93 |
| 16500 16699 |
83 |
|
18700 18899 |
94 |
| 16700 16899 |
84 |
|
18900 19099 |
95 |
| 16900 17099 |
85 |
|
19100 19299 |
96 |
| 17100 17299 |
86 |
|
19300 19499 |
97 |
| 17300 17499 |
87 |
|
19500 19699 |
98 |
| 17500 17699 |
88 |
|
19700 19899 |
99 |
| 17700 17899 |
89 |
|
19900 20099 |
100 |
| 17900 18099 |
90 |
|
|
|
| Note: |
For calculating contribution more than wages 20,099 please multiply the figure shown above up to your figure as: |
| |
Calculation of total wages of Rs 1,10,556 = w, |
|
| |
First multiply 20,000 5=100000=100 5= 500 |
|
| |
10556 = 53 |
|
| |
First amount may please see in the chart. |
|
| |
Net contributionRs 553.00 |
|