The Employees' Provident Fund Scheme, 1952

Paragarph 43

Form - 6A

Employees' Pension Scheme, 1995

Annual statement of contribution for the currency period 1st April Name & Address of the Establishment Code No. of Establishment Wages retaining Amount of allowances (if any) Workers & DA including cash contribution value of food deducted concession paid from the during the currency wages period. 4 5 Sri Lakshmi Vinayagar Shoes 2008 to 31st March 2009 12.00 % NIL

Statutory rate of contribution

No. of members voluntarily contributing at a higher rate:

Sr. No.

Account No. TN/VL/74611

Name of the Member (in BLOCK letters)

EPF between 10% & 8-1/3% 6

Pension Fund 8-1/3%

Total

Refund of Advance

Rate of higher voluntary

contribution

Remarks

(if any) 7 8 9 10

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Grand Total Rs.

0.00

0.00

0.00

0.00

0.00

The Employees' Provident Fund Scheme, 1952

Paragarph 43

Form - 6A

Employees' Pension Scheme, 1995

Annual statement of contribution for the currency period 1st April Name & Address of the Establishment Code No. of Establishment Sri Lakshmi Vinayagar Shoes 2008 to 31st March 2009 12.00 % NIL

Statutory rate of contribution

No. of members voluntarily contributing at a higher rate:

Month Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Total

Wages

A/c.No. 1

A/c.No. 10

A/c.No. 2

A/c.No. 21

A/c.No. 22

0.00

0.00

0.00

0.00

0.00

0.00

Total 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00