FORM No 5A Date : 20-Feb-2024

EMPLOYEES' PROVIDENT FUND SCHEME 1952 (Please refer Para 36A)

EMPLOYEES' PENSION SCHEME 1995 (Please refer Para )

EMPLOYEES' DEPOSIT LINKED INSURANCE SCHEME1976 (Please refer Para

(Ist RETURN OF OWNERSHIP AFTER ONLINE APPLICATION FOR CODE NUMBER)

[THIS FORM 5A HAS BEEN GENERATED BY ONLINE FILLING/ UPDATION OF FORM 5A THROUGH ECR LOGIN
OF EMPLOYER. APPLICATION NUMBER IS 10000328722.]
Code Number : GJAHD2053633000

1. Name of Establishment : ARVIND ENGINEERED COMPOSITE PANELS PRIVATE LIMITED

2. Code Number of the Establishment under EPF Scheme : GJAHD2053633000

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3. Postal address of the Establishment and : Arvind Limited Premises, Old Arvind International Premises, Khatraj
its branches [Please see Annexure Kalol, GANDHINAGAR, GUJARAT - 382721

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4. Industry or business in which engaged : OTHERS

5. Date of commencement of business : 22/03/2019

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6. Date of closure by previous : N/A

7. Whether run by owner or lessee : Run by Lessee

8. Particulars of owners :
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S. Name Date of Status Father's Name Residential Position
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No. Birth Address Date
1 Mr. KETAN SHAH 19/04/1972 SENIOR CHANDRAKANT C 5 PARTH AVENUE 10/09/2015
MANAGER SHAH APPARTMENT NEAR
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ER NALANDA HIGH
SCHOOL GHATLODIA
AHMEDABAD GUJARAT
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380061
2 Mr. ASHISHKUMAR 12/06/1969 DIRECTOR HARIMOHAN B-12, SILVER PALM 06/12/2018
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HARIMOHAN SRIVASTAVA SHERWOOD

SRIVASTAVA APARTMENTS
MARATHAHALLI
COLONY BENGALURU
BANGALORE URBAN
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KARNATAKA 560037
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3 Mr. PUNIT LALBHAI 12/03/1982 DIRECTOR SANJAY LALBHAI LALBAUG SHAHIBAUG 06/12/2018
SHAHIBAUG
AHMEDABAD GUJARAT
380004
4 Mr. TARWANI NAESH 01/12/1967 VICE KEVALRAM GALA ETRNIA, C 1302, 15/12/2011
PRESIDEN 13 FLOOR, DRIVEN
T THALTEJ AHMEDABAD
9. In case on lease, particulars of lessee :

S.No. Name Date of Birth Father's Name Residential Address Position

Date

Application Number : 10000328722 Page 1 of 5

Code Number : GJAHD2053633000

 S.No. Name Date of Birth Father's Name Residential Address Position
Date
1 Mr. BIJAY KUMAR 25/04/1974 GHANSHYAM DAS FLAT 1004, ALPS BLOCK, 03/04/2018
AGARWAL AGARWAL HERITAGE ESTATE
DODABALLAPUR, MAIN
ROAD YELAHANKA,
BENGALURU
560064
10. If registered under Factories Act, particulars of Manager or : N/A

11. Particulars of persons mentioned above who are incharge and responsible for conduct of business of the

S. Name Date of Status Father's Name Residential Position

No. Birth Address Date

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1 Mr. KETAN SHAH 19/04/1972 SENIOR CHANDRAKANT C 5 PARTH AVENUE 10/09/2015
MANAGER SHAH APPARTMENT NEAR

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ER NALANDA HIGH
SCHOOL GHATLODIA
AHMEDABAD GUJARAT
380061

Date:

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Application Number : 10000328722 Page 2 of 5

Code Number : GJAHD2053633000

 ANNEXURE - I

Details of Branches of the Establishment

ANNEXURE - II

List of Branches having Separate/ Sub Code Number

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ANNEXURE - III

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Details of Bank Account Number
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No. IFSC CODE BANK NAME BRANCH NAME ACCOUNT NO ACCOUNT TYPE PRIMARY
ACCOUNT

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1 HDFC000000 HDFC BANK AHMEDABAD - 57500000317241 CURRENT YES
6 NAVRANGPURA
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Copy of cheque of the primary account number : 57500000317241
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Application Number : 10000328722 Page 3 of 5

Code Number : GJAHD2053633000

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Application Number : 10000328722 Page 4 of 5

Code Number : GJAHD2053633000

 SPECIMEN SIGNATURE CARD

To be submitted with all documents after the Code number is allotted through the online application.

FULL NAME OF THE AUTHORISED SIGNATORY __________________________________________________

Name of Establishment : ARVIND ENGINEERED COMPOSITE PANELS PRIVATE LIMITED

Address of the Establishment : Arvind Limited Premises, Old Arvind International Premises, Khatraj Kalol, GANDHINAGAR,
GUJARAT - 382721
Code Number of the : GJAHD2053633000

STATUS OF THE SIGNATORY : # EMPLOYER / AUTHORISED SIGNATORY

# Strike whichever is not applicable

SPECIMEN SIGNATURE 1. _____________________________

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2. _____________________________

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3. _____________________________

SPECIAL INSTRUCTION, IF ANY _______________________________________________________

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SPECIMEN SIGNATURE OF Mr/Ms _______________________________________________________ ATTESTED

Signature of employer _____________________________

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Name of Employer _____________________________

Designation of Employer _____________________________

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Seal of Establishment Mobile number _____________________________

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[ ] Please tick if "Not Applicable" due to upload of digital signature

To be submitted separately for each Authorised Officer, if more than one.

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Not to be submitted in this format if the employer after allotment of code number has uploaded digital signatures of the
Authorised signatories.
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In such case the letter generated from the portal after uploading the digital signature(s) to be sent.

In case of upload of digital signature, when page (6) specimen signature card is not applicable, strike this, but keep as
enclosure to the form 5A.
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Application Number : 10000328722 Page 5 of 5

Code Number : GJAHD2053633000