Muster Roll Cum Wages Register
I have attached format of Form 11 (See Rule 27) (1) Muster Roll Cum Wages Register.
(FOR UNEXEMPTED ESTABLISHMENTS ONLY)
THE EMPLOYEES’ PROVIDENT FUND SCHEME, 1952
THE EMPLOYEES’ FAMILY PENSION SCHEME 1971
Declaration by a person taking up employment in an establishment in which the Employees Provident Fund and Family Pension Fund Scheme are in Force.
I, ____________________________________son/wife/daughter of Shri / Smt. _________________________ do hereby solemnly declare that
(a) I was last employed in M/s _________________________________________________________
(Name & full address of the establishment)
and left services on _______________________________________(Prior to that I was employed with
M/s____________________________________ from _______________to ______________
(b) I was a member of _____________________________________________Provident Fund and also of the family pension fund from ________________________to ___________________and my account number(s) was / were ___________________________________________________
(c) I have / have not withdrawn the amount of my Provident Family Pension Scheme.
(d) I have / have not drawn superannuation benefits in respect of my past services from an employer.
(e) I have never been a member of any Provident fund and / or Family Pension Scheme.
Date ___________________________ Signature or right / left hand thumb impression of the employee.
(To be filled in by the employer only when the person employed had not already been a member of the Employees’ Provident Fund)
Shri_______________________________________ is appointed as _______________________________
(Name of the employee) (Designation)
(Name of the Factory / establishment)
with effect from ______________________________.
(Date of Appointment)
Date_________________________ Signature of the employer or Manager or other authorized Officer
N.B.: The Principal employer should have filled it up also n respect of employees to be employed by through a contractor.