K.M.

ASSOCIATES
Shop No.10 Manibhadra Complex Nr. Vibhaji School Jamnagar 361001
EPF Code No. GJ/75374
SITE NAME : GUJARAT REGION
STATEMENT OF EPF RECOVERY :JUNE-2010
Sl.
EPF A/c No.
No.
1
2
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58

60
62
63
64
65
68
69
70
72
73
77
78
79
80
81
174
177
180
181
182
183
184
185
186
187
188
189
190
191
193
194
195
196
197
198
200
201
202
203
204
206
207
208
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225

Name of Employee
3
SATENDRA KUMAR
BHARAT LAL BARTHWAL
MUKESH KUMAR
SHASHI KANT MISHRA
AMIT KUMAR SHARMA
CHANDAN KUAMAR PANDEY
SURESH KUMAR GAUTAM
ARUN TIWARI
BIPLAB MISHRA
MD. MUSTAFA ANSARI
RAMCHANDER YADAV
AJIJ KHAN
RAJU CHAUHAN
RAHUL KUMAR RAI
GAUTAM KARMAKAR
RAJU SINGH
KISAN SWROOP SHARMA
SHIV CHAN SAHU
MD.RIZWAN ANSARI
RAJESH KUMAR RAI
RAMBABU SHARMA
VED PAL
AKASH
GORAKH SAH
VIRENDRA KUMAR
ANISH
GOPAL SINGH
RAMBABU PANDIT
SANJIV SAHA
RAMESH CHAND GAUTAM
SHASHI KANT SINGH
SHASHI KUMAR
SANTASHWAR TIWARI
ANJANI PANDEY
KRISHNA NAND
PRADEEP KUMAR MISHRA
MD. YASEEN
SHISH RAM SAGAR
DILEEP KUMAR PANDEY
MANISH PANDEY
PANKAJ KUMAR SISODA
PARMANAND SINGH
BALMIKIKI UPADHAYAY
ROHIT KUMAR SHARMA
VIPIN KUMAR
LAXUMAN PRASAD
SUNIL THAKUR
WAKIL KUMAR
RAMESH CHAUBEY
RABINDRA KUMAR
SHAILENDRA GAUTEM
NAGENDRA SINGH
NEERAJ SHARMA
TUNNA DAS
UMESH CHAND
RAM KUMAR SHARMA
SHANKAR KUMAR
SAILENDRA PRATAP

EPF Recovery
Basic
@ 12% 3.67% 8.33%
4
5
3795
4618
3661
4803
4161
2163
4327
185
3994
4803
3325
2771
4803
4161
2627
2496
1478
4434
0
4161
3994
4249
3795
2481
4434
3795
369
4803
3994
4803
2829
3879
4803
4618
3357
4327
4803
4249
2217
3795
4803
4064
3795
4161
4327
4618
3795
4803
4327
4803
4327
2586
4249
4618
3994
4803
3140
4327

Page 1 of 60

455
554
439
576
499
260
519
22
479
576
399
333
576
499
315
300
177
532
0
499
479
510
455
298
532
455
44
576
479
576
339
465
576
554
403
519
576
510
266
455
576
488
455
499
519
554
455
576
519
576
519
310
510
554
479
576
377
519

139
169
134
176
153
79
159
7
147
176
122
102
176
153
96
92
54
163
0
153
147
156
139
91
163
139
14
176
147
176
104
142
176
169
123
159
176
156
81
139
176
149
139
153
159
169
139
176
159
176
159
95
156
169
147
176
115
159

316
385
305
400
347
180
360
15
333
400
277
231
400
347
219
208
123
369
0
347
333
354
316
207
369
316
31
400
333
400
236
323
400
385
280
360
400
354
185
316
400
339
316
347
360
385
316
400
360
400
360
215
354
385
333
400
262
360

TOTAL

Rmks
6

911
1108
879
1153
999
519
1038
44
959
1153
798
665
1153
999
630
599
355
1064
0
999
959
1020
911
595
1064
911
89
1153
959
1153
679
931
1153
1108
806
1038
1153
1020
532
911
1153
975
911
999
1038
1108
911
1153
1038
1153
1038
621
1020
1108
959
1153
754
1038

KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA

K.M.ASSOCIATES
Shop No.10 Manibhadra Complex Nr. Vibhaji School Jamnagar 361001
EPF Code No. GJ/75374
SITE NAME : GUJARAT REGION
STATEMENT OF EPF RECOVERY :JUNE-2010
Sl.
EPF A/c No.
No.
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123

227
228
229
230
310
311
312
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
450
451
452
453
455
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
591
592
593
594
595
596
597
598
599
600
601

Name of Employee
RAJIV GAUTAM
MANJESH PAL
BHUPENDRA ARYA
PANKAJ KUMAR SHARMA
HARENADAR SAH
SANJAY KUMAR SINGH
HEMCHANDRA GAUTAM
PANKAJ KUMAR
RAM PRAKESH
AJAY KUMAR
PRAMOD KUMAR
RAMPAL
RAVI SANKER DUBEY
PAWAN KUMAR
KAMAL ASRAF
ASHOK KUMAR
VINESH SINGH
AJAY KUMAR
TEHARA HUSSAIN
PARSHU RAM
RAKESH KUMAR DHAKAD
MAHENDER KUMAR PANDEY
VIKAS SINGH
RAVI PRAKASH TIWARI
GOPAL SINGH
RAJAN SINGH
BACHCHAN BABU
VINOD CHAUHAN
AMRIT LAL
RAVI RANJAN DUBEY
JAY PRAKASH CHOUHAN
PRATAP SINGH
DAVBUSHNAN SHUKLA
DHIRENDAR SINGH
SUNIL KUMAR SINGH
AUNISH BHARDWAJ
UDAY BHAN SINGH
DINESH DUBEY
RAVI KANT MISHRA
PROMOD KUMAR SHARMA
SAJAL KUMAR RAI
HANUMANT RAM VAISH
FAISAL KHALIL
NAND KISHOR SHARMA
DINESH VISHWAKARMA
DHARMENDRA KUMAR YADAV
SHIV KUMAR SHARMA
DAUDAYAL SINGH TARKAR
RAJ KUMAR MEHTA
BAIDYANATH PRASAD
MR.SANJAY SINGH
AJAY KUMAR MANDAL
SATISH KUMAR SINGH
BIJENDRA SINGH NIRWAN
RAJKUMAR SHARMA
VINOD KUMAR
AMAR DEEP UPADHYAY
SHATRUDHAN CHOUDHARY
RAMESHAR D. SAROJ
ABHISHEKH SINGH
SUBHASH CHOUDHRY
MOHMD UMAR
VIJENDRA SINGH
ASHOK KUMAR
BHAGWAN WALA

EPF Recovery
Basic
@ 12% 3.67% 8.33%
3795
3795
1606
3357
2627
4327
4161
4803
4434
4249
3649
3994
3510
4327
4803
3795
4327
4161
4064
3325
4327
3994
3994
3795
4803
4161
4803
3879
4327
730
4327
3503
4327
3661
3795
4618
4803
1831
4327
4803
4327
4161
4327
3325
3661
4327
4327
4161
4803
2217
4803
3795
4327
3994
3795
2481
1752
2163
1997
1663
1168
1478
876
369
4803
Page 2 of 60

455
455
193
403
315
519
499
576
532
510
438
479
421
519
576
455
519
499
488
399
519
479
479
455
576
499
576
465
519
88
519
420
519
439
455
554
576
220
519
576
519
499
519
399
439
519
519
499
576
266
576
455
519
479
455
298
210
260
240
200
140
177
105
44
576

139
139
59
123
96
159
153
176
163
156
134
147
129
159
176
139
159
153
149
122
159
147
147
139
176
153
176
142
159
27
159
129
159
134
139
169
176
67
159
176
159
153
159
122
134
159
159
153
176
81
176
139
159
147
139
91
64
79
73
61
43
54
32
14
176

316
316
134
280
219
360
347
400
369
354
304
333
292
360
400
316
360
347
339
277
360
333
333
316
400
347
400
323
360
61
360
292
360
305
316
385
400
153
360
400
360
347
360
277
305
360
360
347
400
185
400
316
360
333
316
207
146
180
166
139
97
123
73
31
400

TOTAL
911
911
385
806
630
1038
999
1153
1064
1020
876
959
842
1038
1153
911
1038
999
975
798
1038
959
959
911
1153
999
1153
931
1038
175
1038
841
1038
879
911
1108
1153
439
1038
1153
1038
999
1038
798
879
1038
1038
999
1153
532
1153
911
1038
959
911
595
420
519
479
399
280
355
210
89
1153

Rmks
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA

K.M.ASSOCIATES
Shop No.10 Manibhadra Complex Nr. Vibhaji School Jamnagar 361001
EPF Code No. GJ/75374
SITE NAME : GUJARAT REGION
STATEMENT OF EPF RECOVERY :JUNE-2010
Sl.
EPF A/c No.
No.
124
125
126
127
128
129

602
603
604
605
606
607

Name of Employee
PRAVEEN KUMAR
KAMLESH KUMAR
GOVARDHAN SINGH
RAHUL PATHAK
GOURAV SHARMA
ANSHUL GARG

GRAND TOTAL

EPF Recovery
Basic
@ 12% 3.67% 8.33%
4327
2481
1831
1847
1293
1498

519
298
220
222
155
180

466194

55943 17109

Page 3 of 60

159
91
67
68
47
55

360
207
153
154
108
125

TOTAL
1038
595
439
443
310
360

38834 111887

Rmks
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA

K.M.ASSOCIATES
Shop No.10 Manibhadra Complex Nr. Vibhaji School Jamnagar 361001

EPF Code No
SITE NAME : KHURJA
STATEMENT OF EPF RECOVERY JUNE-2010
Sl.
No.
1

EPF A/c No.

2

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44

62
65
174
69
73
77
78
79
183
184
187
188
189
190
193
196
198
200
201
202
206
211
214
215
217
218
219
222
224
225
229
314
315
316
319
320
322
323
324
329
330
334
335
336

Name of Employee
3
BHARAT LAL BARTHWAL
AMIT KUMAR SHARMA
RAJU SINGH
SURESH KUMAR GAUTAM
MD. MUSTAFA ANSARI
RAMCHANDER YADAV
AJIJ KHAN
RAJU CHAUHAN
RAMBABU SHARMA
VED PAL
VIRENDRA KUMAR
ANISH
GOPAL SINGH
RAMBABU PANDIT
RAMESH CHAND GAUTAM
SANTASHWAR TIWARI
KRISHNA NAND
PRADEEP KUMAR MISHRA
MD. YASEEN
SHISH RAM SAGAR
PANKAJ KUMAR SISODA
ROHIT KUMAR SHARMA
SUNIL THAKUR
WAKIL KUMAR
RABINDRA KUMAR
SHAILENDRA GAUTEM
NAGENDRA SINGH
UMESH CHAND
SHANKAR KUMAR
SAILENDRA PRATAP
BHUPENDRA ARYA
PANKAJ KUMAR
RAM PRAKESH
AJAY KUMAR
RAVI SANKER DUBEY
PAWAN KUMAR
ASHOK KUMAR
VINESH SINGH
AJAY KUMAR
VIKAS SINGH
RAVI PRAKASH TIWARI
VINOD CHAUHAN
AMRIT LAL
RAVI RANJAN DUBEY

EPF Recovery
Basic
@ 12%
4
5
4618
4161
2496
4327
4803
3325
2771
4803
3994
4249
4434
3795
369
4803
4803
4803
3357
4327
4803
4249
4803
4161
3795
4803
4803
4327
2586
3994
3140
4327
1606
4803
4434
4249
3510
4327
3795
4327
4161
3994
3795
3879
4327
730

Page 4 of 60

554
499
300
519
576
399
333
576
479
510
532
455
44
576
576
576
403
519
576
510
576
499
455
576
576
519
310
479
377
519
193
576
532
510
421
519
455
519
499
479
455
465
519
88

3.67%

8.33%

169
153
92
159
176
122
102
176
147
156
163
139
14
176
176
176
123
159
176
156
176
153
139
176
176
159
95
147
115
159
59
176
163
156
129
159
139
159
153
147
139
142
159
27

385
347
208
360
400
277
231
400
333
354
369
316
31
400
400
400
280
360
400
354
400
347
316
400
400
360
215
333
262
360
134
400
369
354
292
360
316
360
347
333
316
323
360
61

45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98

450
451
452
453
455
457
458
459
460
461
462
60
63
64
68
70
72
80
81
177
180
182
185
186
191
194
195
197
203
204
207
208
230
212
213
216
220
221
223
227
228
310
311
312
317
318
321
325
326
327
328
331
332
333

JAY PRAKASH CHOUHAN

PRATAP SINGH
DAVBUSHNAN SHUKLA
DHIRENDAR SINGH
SUNIL KUMAR SINGH
AUNISH BHARDWAJ
UDAY BHAN SINGH
DINESH DUBEY
RAVI KANT MISHRA
PROMOD KUMAR SHARMA
SAJAL KUMAR RAI
SATENDRA KUMAR
MUKESH KUMAR
SHASHI KANT MISHRA
CHANDAN KUAMAR PANDEY
ARUN TIWARI
BIPLAB MISHRA
RAHUL KUMAR RAI
GAUTAM KARMAKAR
KISAN SWROOP SHARMA
SHIV CHAN SAHU
RAJESH KUMAR RAI
AKASH
GORAKH SAH
SANJIV SAHA
SHASHI KANT SINGH
SHASHI KUMAR
ANJANI PANDEY
DILEEP KUMAR PANDEY
MANISH PANDEY
PARMANAND SINGH
BALMIKIKI UPADHAYAY
PANKAJ KUMAR SHARMA
VIPIN KUMAR
LAXUMAN PRASAD
RAMESH CHAUBEY
NEERAJ SHARMA
TUNNA DAS
RAM KUMAR SHARMA
RAJIV GAUTAM
MANJESH PAL
HARENADAR SAH
SANJAY KUMAR SINGH
HEMCHANDRA GAUTAM
PRAMOD KUMAR
RAMPAL
KAMAL ASRAF
TEHARA HUSSAIN
PARSHU RAM
RAKESH KUMAR DHAKAD
MAHENDER KUMAR PANDEY
GOPAL SINGH
RAJAN SINGH
BACHCHAN BABU
Page 5 of 60

4327
3503
4327
3661
3795
4618
4803
1831
4327
4803
4327
3795
3661
4803
2163
185
3994
4161
2627
1478
4434
4161
3795
2481
3994
2829
3879
4618
2217
3795
4064
3795
3357
4327
4618
4327
4249
4618
4803
3795
3795
2627
4327
4161
3649
3994
4803
4064
3325
4327
3994
4803
4161
4803

519
420
519
439
455
554
576
220
519
576
519
455
439
576
260
22
479
499
315
177
532
499
455
298
479
339
465
554
266
455
488
455
403
519
554
519
510
554
576
455
455
315
519
499
438
479
576
488
399
519
479
576
499
576

159
129
159
134
139
169
176
67
159
176
159
139
134
176
79
7
147
153
96
54
163
153
139
91
147
104
142
169
81
139
149
139
123
159
169
159
156
169
176
139
139
96
159
153
134
147
176
149
122
159
147
176
153
176

360
292
360
305
316
385
400
153
360
400
360
316
305
400
180
15
333
347
219
123
369
347
316
207
333
236
323
385
185
316
339
316
280
360
385
360
354
385
400
316
316
219
360
347
304
333
400
339
277
360
333
400
347
400

99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128

463
464
465
466
467
468
469
470
471
472
473
474
475
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607

HANUMANT RAM VAISH

FAISAL KHALIL
NAND KISHOR SHARMA
DINESH VISHWAKARMA
DHARMENDRA KUMAR YADAV
SHIV KUMAR SHARMA
DAUDAYAL SINGH TARKAR
RAJ KUMAR MEHTA
BAIDYANATH PRASAD
MR.SANJAY SINGH
AJAY KUMAR MANDAL
SATISH KUMAR SINGH
BIJENDRA SINGH NIRWAN
RAJKUMAR SHARMA
VINOD KUMAR
AMAR DEEP UPADHYAY
SHATRUDHAN CHOUDHARY
RAMESHAR D. SAROJ
ABHISHEKH SINGH
SUBHASH CHOUDHRY
MOHMD UMAR
VIJENDRA SINGH
ASHOK KUMAR
BHAGWAN WALA
PRAVEEN KUMAR
KAMLESH KUMAR
GOVARDHAN SINGH
RAHUL PATHAK
GOURAV SHARMA
ANSHUL GARG
TOTAL

13.61

Page 6 of 60

4161
4327
3325
3661
4327
4327
4161
4803
2217
4803
3795
4327
3994
3795
2481
1752
2163
1997
1663
1168
1478
876
369
4803
4327
2481
1831
1847
1293
1498
466194

499
519
399
439
519
519
499
576
266
576
455
519
479
455
298
210
260
240
200
140
177
105
44
576
519
298
220
222
155
180
55943

153
159
122
134
159
159
153
176
81
176
139
159
147
139
91
64
79
73
61
43
54
32
14
176
159
91
67
68
47
55
17109

63449.003

Total

119392

347
360
277
305
360
360
347
400
185
400
316
360
333
316
207
146
180
166
139
97
123
73
31
400
360
207
153
154
108
125
38834

Page 7 of 60

Page 8 of 60

Page 9 of 60

Page 10 of 60

Page 11 of 60

Page 12 of 60

Page 13 of 60

Page 14 of 60

61001
EPF Code No. GJ/75374

TOTAL

Rmks
6

1108
999
599
1038
1153
798
665
1153
959
1020
1064
911
89
1153
1153
1153
806
1038
1153
1020
1153
999
911
1153
1153
1038
621
959
754
1038
385
1153
1064
1020
842
1038
911
1038
999
959
911
931
1038
175

KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
Page 15 of 60

1038
841
1038
879
911
1108
1153
439
1038
1153
1038
911
879
1153
519
44
959
999
630
355
1064
999
911
595
959
679
931
1108
532
911
975
911
806
1038
1108
1038
1020
1108
1153
911
911
630
1038
999
876
959
1153
975
798
1038
959
1153
999
1153

KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA

09.06.2010

Page 16 of 60

999
1038
798
879
1038
1038
999
1153
532
1153
911
1038
959
911
595
420
519
479
399
280
355
210
89
1153
1038
595
439
443
310
360
111887

KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA
KHURJA

Page 17 of 60

Page 18 of 60

Page 19 of 60

Page 20 of 60

Page 21 of 60

Page 22 of 60

Page 23 of 60

Page 24 of 60

Page 25 of 60

FORM-05

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME: GUJARAT REGION
Code No. of the Establishment : GJ/75374
Sl
EPF
Name of the Employee
Date of
Ttl prd
Father's/husband's Name
Age
Sex
Rmks
No. Account No.
Elgblty
of servce
9
GJ/RJT/75374/591 RAJKUMAR SHARMA
RAMNIWAS SHARMA
24
M 01.06.2010 1 MONTH KHURJA
10 GJ/RJT/75374/592 VINOD KUMAR
CHHOTAN SINGH
01.03.1983 M 09.06.2010 1 MONTH KHURJA
11 GJ/RJT/75374/593 AMAR DEEP UPADHYAY
SATISH SHARMA
28.11.1991 M 16.06.2010 1 MONTH KHURJA
12 GJ/RJT/75374/594 SHATRUDHAN CHOUDHARY
RAJENDRA CHOUDHRY
05.06.1972 M 16.04.2010 3 MONTH KHURJA
13 GJ/RJT/75374/595 RAMESHAR D. SAROJ
SHRI DEVIDEEN SAROJ
10.10.1959 M 17.06.2010 1 MONTH KHURJA
14 GJ/RJT/75374/596 ABHISHEKH SINGH
RAMNARESH SINGH
10.04.1987 M 21.06.2010 1 MONTH KHURJA
15 GJ/RJT/75374/597 SUBHASH CHOUDHRY
CHANDRABEER SINGH
01.01.1975 M 22.06.2010 1 MONTH KHURJA
16 GJ/RJT/75374/598 MOHMD UMAR
LT. IMDAD ALI
21.01.1986 M 22.06.2010 1 MONTH KHURJA
17 GJ/RJT/75374/599 VIJENDRA SINGH
CHIRANJI LAL
10.07.1983 M 24.06.2010 1 MONTH KHURJA
18 GJ/RJT/75374/600 ASHOK KUMAR
RAM SARAN
20.08.1979 M 29.06.2010 1 MONTH KHURJA
19 GJ/RJT/75374/601 BHAGWAN WALA
SHRI NADHAB WALA
25.04.1986 M 01.06.2010 1 MONTH KHURJA
20 GJ/RJT/75374/602 PRAVEEN KUMAR
MAHENDRA SINGH
01.07.1985 M 01.06.2010 1 MONTH KHURJA
21 GJ/RJT/75374/603 KAMLESH KUMAR
SHIVSHANKER RAM
20.09.1987 M 11.06.2010 1 MONTH KHURJA
22 GJ/RJT/75374/604 GOVARDHAN SINGH
RAM KUVAR SINGH
10.01.1986 M 18.06.2010 1 MONTH KHURJA
23 GJ/RJT/75374/605 RAHUL PATHAK
LT. SRI D.S. PATHAK
01.09.1979 M 18.06.2010 1 MONTH KHURJA
24 GJ/RJT/75374/606 GOURAV SHARMA
RAM PRATAP SHARMA
19.07.1984 M 21.06.2010 1 MONTH KHURJA
25 GJ/RJT/75374/607 ANSHUL GARG
SHRI VIJAY GARG
02.07.1988 M 18.06.2010 1 MONTH KHURJA

Page 26 of 60

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME: UREN CRUSHER
Sl
No.
1

EPF
Name of the Employee
Account No.
GJ/RJT/75374/583 VIJAY KUMAR

Father's/husband's Name
KANNAYA PRASAD

Age

Sex

01.01.1967

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
1 MONTH

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME: TRIVENDRAM
Sl
No.
1
2

EPF
Name of the Employee
Account No.
GJ/RJT/75374/584 P.MUTHU PANDI
GJ/RJT/75374/585 A.R.RAMESH

Father's/husband's Name
S.PERIYA MUNIYANDI
A.V.RATHINA VEL

Page 27 of 60

Age

Sex

24
41

M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
2-Jun-10
2-Jun-10

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME: GODREJ
Sl
No.
1
2
3
4
5

EPF
Account No.
GJ/RJT/75374/586
GJ/RJT/75374/587
GJ/RJT/75374/588
GJ/RJT/75374/589
GJ/RJT/75374/590

Name of the Employee

MD MOBIN
NEETU SINGH
VIKAS SINGH
SANTOSH PRASAD
PARAM HANS YADAV

Father's/husband's Name
MD HASIM
KARAN SINGH
VIKRAM SINGH
BADLU PRASAD
FUL CHAND YADAV

Age

Sex

43
25
22
26
26

M
M
M
M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
1 MONTH
10.06.2010
1 MONTH
21.06.2010
1 MONTH
22.06.2010
1 MONTH
29.06.2010
1 MONTH

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME: KHURJA
Sl
No.
1
2
3

EPF
Account No.
GJ/RJT/75374/591
GJ/RJT/75374/592
GJ/RJT/75374/593

Name of the Employee

RAJKUMAR SHARMA
VINOD KUMAR
AMAR DEEP UPADHYAY

Father's/husband's Name
RAMNIWAS SHARMA
CHHOTAN SINGH
SATISH SHARMA

Page 28 of 60

Age
24
01.03.1983
28.11.1991

Sex
M
M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
09.06.2010
16.06.2010

4
5

GJ/RJT/75374/594 SHATRUDHAN CHOUDHARY

GJ/RJT/75374/595 RAMESHAR D. SAROJ

RAJENDRA CHOUDHRY
SHRI DEVIDEEN SAROJ

Page 29 of 60

05.06.1972
10.10.1959

M
M

16.04.2010
17.06.2010

6
7
8
9
10
11
12
13
14
15
16
17

GJ/RJT/75374/596
GJ/RJT/75374/597
GJ/RJT/75374/598
GJ/RJT/75374/599
GJ/RJT/75374/600
GJ/RJT/75374/601
GJ/RJT/75374/602
GJ/RJT/75374/603
GJ/RJT/75374/604
GJ/RJT/75374/605
GJ/RJT/75374/606
GJ/RJT/75374/607

ABHISHEKH SINGH
SUBHASH CHOUDHRY
MOHMD UMAR
VIJENDRA SINGH
ASHOK KUMAR
BHAGWAN WALA
PRAVEEN KUMAR
KAMLESH KUMAR
GOVARDHAN SINGH
RAHUL PATHAK
GOURAV SHARMA
ANSHUL GARG

RAMNARESH SINGH
CHANDRABEER SINGH
LT. IMDAD ALI
CHIRANJI LAL
RAM SARAN
SHRI NADHAB WALA
MAHENDRA SINGH
SHIVSHANKER RAM
RAM KUVAR SINGH
LT. SRI D.S. PATHAK
RAM PRATAP SHARMA
SHRI VIJAY GARG

10.04.1987
01.01.1975
21.01.1986
10.07.1983
20.08.1979
25.04.1986
01.07.1985
20.09.1987
10.01.1986
01.09.1979
19.07.1984
02.07.1988

M
M
M
M
M
M
M
M
M
M
M
M

21.06.2010
22.06.2010
22.06.2010
24.06.2010
29.06.2010
01.06.2010
01.06.2010
11.06.2010
18.06.2010
18.06.2010
21.06.2010
18.06.2010

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME:MANESWAR
Sl
No.
1
2
3
4
5
6
7
8

EPF
Account No.
GJ/RJT/75374/608
GJ/RJT/75374/609
GJ/RJT/75374/610
GJ/RJT/75374/611
GJ/RJT/75374/612
GJ/RJT/75374/613
GJ/RJT/75374/614
GJ/RJT/75374/615

Name of the Employee

BHARAT SINGH
NAVEEN PAL
MANOJ KUMAR
CHANDRA BHAN SINGH
ASHISH KUMAR
ANIL KUMAR
PRADEEP KUMAR
BHIM SINGH

Father's/husband's Name
ABHIMANYU SINGH
SATYA PAL
BHGAWANA RAM
BUDDHPAL SINGH
VISHMBHAR SINGH
OM PRAKASH
RAGHUNATH
RAM SOBHIT

Page 30 of 60

Age

Sex

27
23
24
28
20
40
32
36

M
M
M
M
M
M
M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
1 MONTH
01.06.2010
1 MONTH
02.06.2010
1 MONTH
04.06.2010
1 MONTH
07.06.2010
1 MONTH
10.06.2010
1 MONTH
10.06.2010
1 MONTH
11.06.2010
1 MONTH

9
10
11
12
13
14
15

GJ/RJT/75374/616
GJ/RJT/75374/617
GJ/RJT/75374/618
GJ/RJT/75374/619
GJ/RJT/75374/620
GJ/RJT/75374/621
GJ/RJT/75374/622

HARI SANKAR PANDAY

BIKRAM MAHTO
VIJAY KUMAR SINGH
VIPIN KUMAR MISHRA
MANOJ KUMAR
RAJA RAM DUBEY
BRUNDABAN KAHAL SINGH

HIRAMAN PANDAY
NARESH MAHTO
RAJ BAHADUR SINGH
MANI KANT MISHRA
CHHAJU RAM
UMAKANT DUBEY
DEVRAJ KAHAL SINGH

Page 31 of 60

48
25
26
23
23
35
30

M
M
M
M
M
M
M

11.06.2010
12.06.2010
15.06.2010
15.06.2010
15.06.2010
16.06.2010
16.06.2010

1 MONTH
1 MONTH
1 MONTH
1 MONTH
1 MONTH
1 MONTH
1 MONTH

16
17
18
19

GJ/RJT/75374/623
GJ/RJT/75374/624
GJ/RJT/75374/625
GJ/RJT/75374/626

BATA KRISHNA OJHA

SUNIL KUMAR
PREM NARAYAN MISHRA
DAYAMAY MANDAL

NABAGHANA OJHA
MAHENDRA SINGH
RAM KHILARI MISHRA
NADIYA MANDAL

37
21
29
26

M
M
M
M

16.06.2010
17.06.2010
26.06.2010
17.06.2010

1 MONTH
1 MONTH
1 MONTH
1 MONTH

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME:SAMALKHA
Sl
No.
1
2
3
4
5
6
7
8
9

EPF
Account No.
GJ/RJT/75374/627
GJ/RJT/75374/628
GJ/RJT/75374/629
GJ/RJT/75374/630
GJ/RJT/75374/631
GJ/RJT/75374/632
GJ/RJT/75374/633
GJ/RJT/75374/634
GJ/RJT/75374/635

Name of the Employee

MANOJ YADAV
DEEPAK KERKETTA
AWADHESH VERMA
KAMTA SINGH
SATPAL
VINAY KR. UPADHAYA
DEVINDER SINGH
LOW KUMAR PANDEY
RAVINDER KUMAR

Father's/husband's Name
RAM YADAV
JULUS KERKETTA
SANKAR VERMA
SUNDER SINGH
BISHAN SINGH
AWADESH UPADHAYA
LAKHBIR SINGH
GORAKHNATH PANDEY
RAM JIT RAM

Page 32 of 60

Age

Sex

37
29
28
39
41
25
19
22
44

M
M
M
M
M
M
M
M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
6/3/2010
6/3/2010
6/11/2010
6/12/2010
6/16/2010
6/23/2010
6/25/2010
6/29/2010
6/29/2010

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME:GANDHINAGAR
Sl
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19

EPF
Account No.
GJ/RJT/75374/636
GJ/RJT/75374/637
GJ/RJT/75374/638
GJ/RJT/75374/639
GJ/RJT/75374/640
GJ/RJT/75374/641
GJ/RJT/75374/642
GJ/RJT/75374/643
GJ/RJT/75374/644
GJ/RJT/75374/645
GJ/RJT/75374/646
GJ/RJT/75374/647
GJ/RJT/75374/648
GJ/RJT/75374/649
GJ/RJT/75374/650
GJ/RJT/75374/651
GJ/RJT/75374/652
GJ/RJT/75374/653
GJ/RJT/75374/654

Name of the Employee

RATISH KUMAR SINGH
JAGADA NAND MISHRA
RASAL BISWASH
UDAY RAJ MORYA
P.SHANMUGARAJ
A.RAMKI
SHYAM SUNDAR
SAILESH BORICHA
V.NATRAJ
PARMAR MAHENDRA
MURUGAN R
VAGELA JITENDRA SINGH
TUNTUN SINGH
BARAD BHAV SINH
ARMAN KHAN
PRAVIN KUMAR TIWARI
MD.SALIM ANSARI
VANKAR ASHOK KUMAR
CHUDASAMA LALJEE

Father's/husband's Name
DEVNATH SINGH
MEDHA NAND MISHRA
RAMENDRA NATH
SATISH CHANDRA MORYA
V.PITCHIAH
AYYODYA RAM
NILKANTH SINGH
RAMESH BHAI
VIRAPPAN
KANAK SINGH
T.RAJENRAN
ARJUN SINGH
GULAB SHAH
BARAD BHIKHA BHAI
AIYAKAT KHAN
ANAND SANKAR TIWARI
MD.ALIMUDDIN ANSARI
KARASAN BHAI
KHODA BHAI CHUDASAMA

Age

Sex

35
40
38
23
26
23
40
20
45
20
26
21
44
34
21
27
22
26
25

M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

Page 33 of 60

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
01.06.2010
1 MONTH
05.06.2010
1 MONTH
09.06.2010
1 MONTH
16.06.2010
1 MONTH
16.06.2010
1 MONTH
16.06.2010
1 MONTH
16.06.2010
1 MONTH
21.06.2010
1 MONTH
14.06.2010
1 MONTH

Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME:CTS SIRUSERI
Sl
No.
1
2
3
4
5
6
7
8
9
10

EPF
Account No.
GJ/RJT/75374/655
GJ/RJTJ/75374/656
GJ/RJT/75374/657
GJ/RJT/75374/658
GJ/RJT/75374/659
GJ/RJT/75374/660
GJ/RJT/75374/661
GJ/RJT/75374/662
GJ/RJT/75374/663
GJ/RJT/75374/664

Name of the Employee

R SELVAGANDHI
PICHAYA
D M SENTHIL NATHAN
R SEKAR
V JEYAKUMAR
B SURESH
V SELVAKUMAR
SUKDEV MANDAL
VENKATA KRISHNA
C K RAJENDIRAN

Father's/husband's Name
M RAMANATHAN
Y. CHINNAIAN
D MOHANACHARI
M RAJI
VASAHAR
BHASKAR
J VELLASAMY
DEENABANDA MANDAL
BHUSHANAM
G KUPPUSAMY

Page 34 of 60

Age

Sex

26
30
25
41
28
26
24
26
36
45

M
M
M
M
M
M
M
M
M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
02.06.2010
02.06.2010
03.06.2010
04.06.2010
04.06.2010
07.06.2010
07.06.2010
07.06.2010
09.06.2010

11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43

GJ/RJT/75374/665
GJ/RJT/75374/666
GJ/RJT/75374/667
GJ/RJT/75374/668
GJ/RJT/75374/669
GJ/RJT/75374/670
GJ/RJT/75374/671
GJ/RJT/75374/672
GJ/RJT/75374/673
GJ/RJT/75374/674
GJ/RJT/75374/675
GJ/RJT/75374/676
GJ/RJT/75374/677
GJ/RJT/75374/678
GJ/RJT/75374/679
GJ/RJT/75374/680
GJ/RJT/75374/681
GJ/RJT/75374/682
GJ/RJT/75374/683
GJ/RJT/75374/684
GJ/RJT/75374/685
GJ/RJT/75374/686
GJ/RJT/75374/687
GJ/RJT/75374/688
GJ/RJT/75374/689
GJ/RJT/75374/690
GJ/RJT/75374/691
GJ/RJT/75374/692
GJ/RJT/75374/693
GJ/RJT/75374/694
GJ/RJT/75374/695
GJ/RJT/75374/696
GJ/RJT/75374/697

C GNANASEKAR
R ARIVAZHAGAN
K N MAHARAJAN
P RADHAKRISHNAN
I DAVID RAJU
R SRIDAR
SANGAMLAL YADAV
P PALSAMY
C KANNAN
D THRINATH
S KASI
N SANTHOSH KUMAR
V PRAKASH
V SELVARAJ
K G MAHADEVAN
ASHOK KUMAR
N SOWRIRAJAN
N RAMKUMAR
DEV PRADHAN
T SEKAR
RAMBHAVAN YADAV
M HARIHARA SUDHAN
M ANUMUTHU
M VENKATA RAMESH
J SUNDAR
A SELVARAJ
P MAHESHWARAN
R CHIDAMBARAM
P SRINIVASAN
A RAJA
GOBINDA JENA
M B DILNAVAJ
K ELUMALAI

R CHOCKALINGAM
K RAJAGOPALAN
K NALLAKANNU
N PALANI
S ASIRWADHAM
R G K MURTHI
GAYADEEN YADAV
PERIYASAMY
S SINNATHAMBI
D DHILARH
R SANKAR
S NAGAPPAN
M VICTOR
K VENKATESAN
K GANTHI
S BADMANABASAMY
NAGARATHINAM
NEELA MAHAKANNAN
KASABA PRADHAN
K TAVASU
CHHEDILAL YADAV
K MARI MUTHU
K MUNUSAMY
M VENKATESWARA RAO
V JAYAPAL
ARUMUGAM
PERIYASAMY
RAMANATHAN
C V PATTAGI
E ARJUNAN
KRISHNA PRASAD
M D NISHAR
K KATHAVARAIYAN

Page 35 of 60

40
26
25
30
42
34
41
51
28
52
36
20
25
25
32
19
42
20
28
41
25
20
45
27
27
49
27
29
36
30
26
19
23

M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M

09.06.2010
09.06.2010
09.06.2010
09.06.2010
09.06.2010
10.06.2010
10.06.2010
11.06.2010
14.06.2010
14.06.2010
14.06.2010
14.06.2010
16.06.2010
16.06.2010
16.06.2010
21.06.2010
23.06.2010
26.06.2010
23.06.2010
23.06.2010
23.06.2010
24.06.2010
24.06.2010
25.06.2010
25.06.2010
26.06.2010
26.06.2010
26.06.2010
26.06.2010
26.06.2010
28.06.2010
28.06.2010
28.06.2010

44
45
46
47
48

GJ/RJT/75374/698
GJ/RJT/75374/699
GJ/RJT/75374/700
GJ/RJT/75374/701
GJ/RJT/75374/702

SUSHANTA MANDAL
M TAMILSELVAN
M OBULESH
S K BABA PAKRUDDIN
PARTHIBAN

SUREN MANDAL
MURUGESAN
M P OBULESH
SIKHANDER BASHA
RAMAKRISHNAN

34
19
27
26
27

M
M
M
M
M

29.06.2010
30.06.2010
30.06.2010
30.06.2010
01.06.2010

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of JUNE-2010
(to be sent to Commissioner with Form-2)
Name & Address of the Establishment : K.M.ASSOCIATES, Shop No. 10 Manibhara Complex, Near Vibhaji School Jamnagar 361001
SITE NAME:ORCHID CROWN
Sl
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14

EPF
Account No.
GJ/RJT/75374/703
GJ/RJT/75374/704
GJ/RJT/75374/705
GJ/RJT/75374/706
GJ/RJT/75374/707
GJ/RJT/75374/708
GJ/RJT/75374/709
GJ/RJT/75374/710
GJ/RJT/75374/711
GJ/RJT/75374/712
GJ/RJT/75374/713
GJ/RJT/75374/714
GJ/RJT/75374/715
GJ/RJT/75374/716

Name of the Employee

DINESH SINGH
NARAYAN MAJHI
SUNAKAR JENA
DHIRENDRA K.SHARMA
GANESH KISHOR MEHER
PATIL RAMAKANT DATTATREY
JAGADISH TRIPATHY
SACHITANANDA TRIPATHY
NITIN PRAKASH MORE
N.S.WAGHMARE
BABLU ANSARI
MD.SIBGATULLAH SHAIKH
MD.MUSTUFA
MD.JAFARALAM

Father's/husband's Name
KALU MAJHI
BHARATH JENA
RAM MURTHI SHARMA
KISHOR GOPAL MEHER
DATTATREY JANU PATIL
DIGAMBER TRIPATHY
RAMAKANTA TRIPATHY
PRAKASH MORE
S.M.WAGMARE
J.H.ANSARI
KALIMULLAH SHAIKH
MD.ILIYAS
MD.ASIM

Page 36 of 60

Age

Sex

1979
1969
1966
1980
1985
1987
1982
1983
1986
1977
1976
1981
1982
1986

M
M
M
M
M
M
M
M
M
M
M
M
M
M

Code No. of the Establishment : GJ/75374

Date of
Ttl prd
Elgblty
of servce
01.06.2010
01.06.2010
01.06.2010
02.06.2010
03.06.2010
03.06.2010
04.06.2010
04.06.2010
07.06.2010
08.06.2010
08.06.2010
08.06.2010
08.06.2010
08.06.2010

15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47

GJ/RJT/75374/717
GJ/RJT/75374/718
GJ/RJT/75374/719
GJ/RJT/75374/720
GJ/RJT/75374/721
GJ/RJT/75374/722
GJ/RJT/75374/723
GJ/RJT/75374/724
GJ/RJT/75374/725
GJ/RJT/75374/726
GJ/RJT/75374/727
GJ/RJT/75374/728
GJ/RJT/75374/729
GJ/RJT/75374/730
GJ/RJT/75374/731
GJ/RJT/75374/732
GJ/RJT/75374/733
GJ/RJT/75374/734
GJ/RJT/75374/735
GJ/RJT/75374/736
GJ/RJT/75374/737
GJ/RJT/75374/738
GJ/RJT/75374/739
GJ/RJT/75374/740
GJ/RJT/75374/741
GJ/RJT/75374/742
GJ/RJT/75374/743
GJ/RJT/75374/744
GJ/RJT/75374/745
GJ/RJT/75374/746
GJ/RJT/75374/747
GJ/RJT/75374/748
GJ/RJT/75374/749

SANGHARATNA BHALERAO
RAVI GAIKWARD
RAVI BHANDARI
PRAKASH NARAYAN WADKAR
ABHAY KHILAR
MD.KHADIR
SHUDODHAN NAMDEV RAUT
VIJAY PANDURANG GHORPADE
SAGAR VENKAT JADHAV
SRINIVAS ROUT
ASHOK BISWAS
KALIPADA BISWAS
KANAI DHALI
NARENDRA KISAN RAO BADGE
LALBHADUR MAURYA
RAVINDRA KUMAR BARAL
PRADIPTA KUMAR PUHAN
SHIVRAJ ARJUN BHALERAO
MEHTRE BABU DAMAJI
P.MUNIKRISHNAN RAO
BALLAL AHMAD
MD.SHAMIM KHAN
GAIKWARD KISWAR SHYAMRAO
BHALERAO ANTI VISHWNATH
GAIKWARD ARVIND SHANKAR
MERLA BHASKAR
MANILAL MANDAL
AJAY KUMAR DUBEY
MOHAMMAD RAHMAN
VARISH ANSARI
ARUN B.SINGH
ABHIJIT VIJAY SINGH PAWAR
KUMAR JAY SINGH

DHANARAJ
DEV DAS GAIKWARD
LINGAYYA BHANDARI
NARAYAN M.WADKAR
GOBINDA KHILAR
MD.MUSLIM
NAMDEV RAUT
PANDURANG K.GHORPADE
VENKAT RAMU JADHAV
DUKHISHYAM ROUT
NARESH CHANDRA BISWAS
NARESH CHANDRA BISWAS
SHIBU DHALI
KISHAN RAO BADGE
GIRIDHARILAL MAURYA
SISIR KUMAR BARAL
RAMCHANDRA PUHAN
ARJUN BHALERAO
DAMAJI MEHTRE
VENKETESH IU
MD.YASIN ANSARI
MD.RAFI KHAN
SHYAMRAO
VISWANATH
SHANKAR GAIKWARD
MERLA KRISHNA
SRI SHRISTIDHAR MANDAL
RAM SHANKAR DUBEY
MAHAMMAD QUADIR
SULTAN ANSARI
B.V.SINGH
VIJAY SINGH PAWAR
RAGHUNANDA SINGH

Page 37 of 60

1989
1990
1978
1980
1984
1986
1988
1985
1986
1982
1969
1977
1989
1986
1985
1977
1972
1982
1981
1985
1978
1977
1988
1985
1984
1980
1987
1980
1981
1984
1980
1989
1968

M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M
M

09.06.2010
09.06.2010
09.06.2010
09.06.2010
10.06.2010
10.06.2010
10.06.2010
11.06.2010
11.06.2010
14.06.2010
14.06.2010
14.06.2010
14.06.2010
15.06.2010
15.06.2010
15.06.2010
15.06.2010
15.06.2010
15.06.2010
15.06.2010
16.06.2010
17.06.2010
21.06.2010
21.06.2010
21.06.2010
21.06.2010
22.06.2010
22.06.2010
23.06.2010
23.06.2010
29.06.2010
29.06.2010
30.06.2010

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

TE NAME: UREN CRUSHER
Code No. of the Establishment : GJ/75374
Rmks

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

ITE NAME: TRIVENDRAM
Code No. of the Establishment : GJ/75374
Rmks

FORM-05

Page 38 of 60

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

SITE NAME: GODREJ
Code No. of the Establishment : GJ/75374
Rmks

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

SITE NAME: KHURJA
Code No. of the Establishment : GJ/75374
Rmks

Page 39 of 60

Page 40 of 60

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

SITE NAME:MANESWAR
Code No. of the Establishment : GJ/75374
Rmks

Page 41 of 60

Page 42 of 60

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

SITE NAME:SAMALKHA
Code No. of the Establishment : GJ/75374
Rmks

FORM-05

Page 43 of 60

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

TE NAME:GANDHINAGAR
Code No. of the Establishment : GJ/75374
Rmks

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

Page 44 of 60

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

SITE NAME:CTS SIRUSERI
Code No. of the Establishment : GJ/75374
Rmks

Page 45 of 60

Page 46 of 60

FORM-05

ROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}

for the first time during the month of JUNE-2010

hara Complex, Near Vibhaji School Jamnagar 361001

TE NAME:ORCHID CROWN
Code No. of the Establishment : GJ/75374
Rmks

Page 47 of 60

Page 48 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : UREN CRUSHER
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
2
HARINATH CHOUHAN
RAMAKANT
1
23.05.2010
RESIGNED
UREN CRUSHER
2
NAVDEEP SINGH
SATPAL SINGH
02.06.2010
RESIGNED
GODREJ
114
3
209
Rakesh Kumar Singh
Chandrika singh
01.06.2010
RESIGNED
KHURJA
4
210
DHANANJAY KUMAR MALL
NAND KUMAR MALL
01.06.2010
RESIGNED
KHURJA
5
75
MOHIN AHMAD
ABDUL AHMAD
02.06.2010
RESIGNED
KHURJA
6
177
KISAN SWROOP SHARMA
SHYAM SUNDER SHARMA
09.06.2010
RESIGNED
KHURJA
7
237
DANVEER
SANTRAM
30.05.2010
RESIGNED
MANISWAR
8
337
SANJAY PD.
KAPILDEV PRASAD
31.05.2010
RESIGNED
MANISWAR
9
495
BIRENDRA PRATAP SINGH
RAJENDRA PRASAD SINGH
01.06.2010
RESIGNED
MANISWAR
FIRAN VISHWEKARMA
FATUA VISHWAKARMA
10
250
07.05.2010
RESIGNED
GANDHINAGAR
RAJPUT GULAB SINGH
TOP SINGH
11
261
07.05.2010
RESIGNED
GANDHINAGAR
PRASHANT SHREEVASTAV
RAJESH KUMAR SHREEVASTAV
12
379
31.05.2010
RESIGNED
GANDHINAGAR
BALMIKI
SAHU
DANDASI
SAHU
13
381
07.05.2010
RESIGNED
GANDHINAGAR
BILBAL NARESH KUMAR
MAN SINGH BHAI
14
384
05.05.2010
RESIGNED
GANDHINAGAR
PANKIL M. SHAH
MAHENDRA KUMAR SHAH
15
386
08.05.2010
RESIGNED
GANDHINAGAR
RAMESH KANDLE
NAMDEV KANDLE
16
534
14.06.2010
RESIGNED
GANDHINAGAR
17
389
V.SUBRAMANIAN
VEMBIAH
30.06.2010
RESIGNED
CTS SIRUSERI
18
393
N.BALAJI
NATARAJAN
05.06.2010
RESIGNED
CTS SIRUSERI
JAGDISH LAHU KADAV
LAHU V.KADAV
30.06.2010
19
403
RESIGNED
ORCHID CROWN
ARUN P.KARADE
PANDHARINATH KARADE
30.06.2010
20
408
RESIGNED
ORCHID CROWN
RAJAYYA M.MANDALA
MALAYYA V.MANDALA
30.06.2010
21
566
RESIGNED
ORCHID CROWN
SHIVSANKAR DUBEY
SANGA PRASAD DUBEY
30.06.2010
22
582
RESIGNED
ORCHID CROWN

Page 49 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : UREN CRUSHER
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
2
HARINATH CHOUHAN
RAMAKANT
23.05.2010
1

Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the name & address of the
employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

Page 50 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : TRIVENDRAM
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service leaving Service

NIL

Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c)
Retrenchment (d) ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the
name & address of the employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

Page 51 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : GODREJ
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
1
NAVDEEP SINGH
SATPAL SINGH
02.06.2010
114
Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the name & address of the
employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

Page 52 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : KHURJA
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
1
GJ/RJT/75374/209 Rakesh Kumar Singh
Chandrika singh
01.06.2010
RESIGNED
2
GJ/RJT/75374/210 DHANANJAY KUMAR MALL
NAND KUMAR MALL
01.06.2010
RESIGNED
3
GJ/RJT/75374/75 MOHIN AHMAD
ABDUL AHMAD
02.06.2010
RESIGNED
4
GJ/RJT/75374/177 KISAN SWROOP SHARMA
SHYAM SUNDER SHARMA
09.06.2010
RESIGNED
Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the name & address of the
employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

Page 53 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : MANISWAR
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
1
237
DANVEER
SANTRAM
30.05.2010
2
337
SANJAY PD.
KAPILDEV PRASAD
31.05.2010
3
495
BIRENDRA PRATAP SINGH
RAJENDRA PRASAD SINGH
01.06.2010
Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the name & address of the
employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

FORM-10

Page 54 of 60

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : GANDHINAGAR
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
FIRAN VISHWEKARMA
FATUA VISHWAKARMA
1
250
07.05.2010
RAJPUT GULAB SINGH
TOP SINGH
2
261
07.05.2010
PRASHANT SHREEVASTAV
RAJESH KUMAR SHREEVASTAV
3
379
31.05.2010
BALMIKI
SAHU
DANDASI
SAHU
4
381
07.05.2010
BILBAL NARESH KUMAR
MAN SINGH BHAI
5
384
05.05.2010
PANKIL M. SHAH
MAHENDRA KUMAR SHAH
6
386
08.05.2010
RAMESH KANDLE
NAMDEV KANDLE
7
534
14.06.2010
Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the name & address of the
employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

Page 55 of 60

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : SAMALKHA
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
NIL
Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
ordinarily dismissed for serious & wilful misconduct (e) discharged (f) resigning from service (g) taking up employment elsewhere (the name & address of the
employer should be stated (h) Death.
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952

Page 56 of 60

{Para 36(2)(a) & (b)}

Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001
Code No. of the Establishment :GJ/75374
SITE NAME : CTS SIRUSERI
Sl EPF
Name of the Employee
Father's/
Date of
Reason for
Rmks.
No. account no.
Husband's Name
Leaving Service
leaving Service
1
389
V.SUBRAMANIAN
VEMBIAH
30.06.2010
2
393
N.BALAJI
NATARAJAN
05.06.2010
Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

FORM-10
EMPOYEES PROVIDENT FUND SCHEME, 1952
{Para 36(2)(a) & (b)}
Return of the members leaving service during the month of JUNE-2010
Name & Address Of The Establishment : K.M.Associates , Shop No.10 Manibhadra Complex Nr.Vibhaji School , Jamnagar - 361 001

Page 57 of 60

Code No. of the Establishment :GJ/75374

Sl
No.
1
2
3
4

EPF
account no.
403
408
566
582

Name of the Employee

JAGDISH LAHU KADAV
ARUN P.KARADE
RAJAYYA M.MANDALA
SHIVSANKAR DUBEY

SITE NAME : ORCHID CROWN

Father's/
Husband's Name
LAHU V.KADAV
PANDHARINATH KARADE
MALAYYA V.MANDALA
SANGA PRASAD DUBEY

Date of
Leaving Service

Reason for
leaving Service

Rmks.

30.06.10
30.06.10
30.06.10
30.06.10

Please state whether the member is (a) Retiring under para 10 (69) (1) or (b) of the scheme (b) leaving India for permanent settlement abroad (c) Retrenchment (d)
A request for the reduction from the account of a member dismissed for serious wilful misconduct should be reserved by the following certificate.
Certified that the member mentioned at Sl. No. ________ Shri. ________________________ was dismissed for serious and wilful misconduct.
Certified that the member mentioned at Sl. No. ________ Shri. ___________________________________ was paid not paid retrenchment.
Compensation of Rs. _______________________________________ under the Indistrial Dispute Act, 1977.

Stamp of the Factory/Establishment

Page 58 of 60

FORM-05

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of ______________________
to Commissioner with Form-2)
Name & Address of the Establishment : ___________________________________________________________________________________________

_______________________________________________________________________
SITE NAME:
Sl
No.

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

EPF
Account No.

Name of the Employee

Father's/husband's Name

Date of Birth

Sex

SAVAN SINGH

CHIRANGI SINGH

1/15/1986

RAJESH SINGH

RAMHARSH SINGH

1/15/1986

KRISHNAKANT PANDEY

BABBAN PANDEY

1/15/1972

RAMSARIKHAN

RAJVANSHI

8/20/1962

RAMNARAYAN RAJBHAR

PACHAN

1/1/1973

PRAMOD SINGH

RAMCHARITRA

8/15/1986

ANIL SINGH

PRADUMMAN

9/20/1990

UDAYVAN SINGH

RAMLAGAN

7/13/1974

PRADEEP SINGH

RAMASHISH

1/20/1977

MUNNA VERMA

HARILAL SHAH

2/1/1985

RAJKISHOR MAHATO

DHRUPLAL

9/18/1977

SATENDRA YADAV

HANSNATH

4/17/1989

RAVINDRA KUSHWAHA

PRABHUNATH

6/10/1985

JAIPRAKASH BHAGAT

RAMAYAN

7/12/1986

AJAY YADAV

HANSNATH

9/13/1974

RAHUL YADAV

RAMAKANT

5/15/1995

JAIRAM YADAV

VANSHRAJ

9/18/1976

BRIJANAND PRASAD

MUKTINATH

3/11/1980

TULSI RAM

FULENA RAM

10/12/1983

JITENDRA RAM

FULENA RAM

11/13/1986

Page 59 of 60

Date of
Elgblty

Code No. of the Establishment :

Ttl prd
Rmks
of servce

FORM-05

EMPOYEES PROVIDENT FUND SCHEME, 1952

{Para 36(2)(b)}
Return of employee qualifying for membership of Employee's Provident Fund for the first time during the month of ______________________
to Commissioner with Form-2)
Name & Address of the Establishment : ___________________________________________________________________________________________

_______________________________________________________________________
SITE NAME:
Sl
No.

EPF
Account No.

Name of the Employee

Father's/husband's Name

Page 60 of 60

Date of Birth

Sex

Date of
Elgblty

Code No. of the Establishment :

Ttl prd
Rmks
of servce