Thanks to visit codestin.com
Credit goes to www.scribd.com

Scribd
Upload
3K views2 pages

Form 10

This document contains a form for employers to report employees leaving service during a given month. The form includes fields for the employee's name, account number, father/husband's name, date of leaving service, and reason for leaving such as retirement, permanent relocation abroad, disability, resignation, or death. Employers must sign and stamp the form, and for some reasons like retrenchment, specify if compensation was paid under the Industrial Dispute Act of 1947. The form is used to track employees leaving their jobs and ending contributions to provident funds.

Uploaded by

Darshan H R
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
3K views2 pages

Form 10

This document contains a form for employers to report employees leaving service during a given month. The form includes fields for the employee's name, account number, father/husband's name, date of leaving service, and reason for leaving such as retirement, permanent relocation abroad, disability, resignation, or death. Employers must sign and stamp the form, and for some reasons like retrenchment, specify if compensation was paid under the Industrial Dispute Act of 1947. The form is used to track employees leaving their jobs and ending contributions to provident funds.

Uploaded by

Darshan H R
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
You are on page 1/ 2

The Employees' Provident Fund Scheme, 1952 Form - 10

Paragarph 36 (2) (a) and (b)

Employees' Pension Scheme, 1995

Paragarph 20 (4)

Return of Members leaving service during the month of :

Name & Address of the Factory/ Establishment :

Code No. of Factory/ Establishment :

Father's Name or
SL Name of the Member (in Date of Leaving Reason for
Account No. Husband's Name in case Remarks
No BLOCK letters) Service Leaving Service
of married women

2
3
4
5

Signature of the employer or other authorised officer and stamp Establishment

Please state whether the member is (a) retiring according to a para (69) (1) (a) or (b) of the scheme (b) Leaving India for permanent
settlement abroad ( C) retirement ( d) Pt. & total disablement due to employment injury (e) discharged (f) resigning from or leaving service
(g) taking up employment elsewhere (the name & address of the Employers shoule be stated) (h) death.

"Certified that the member mentioned at Serial No………Shri……………………………………………..was paid / not paid
retrenchment compensation of Rs. _________________________under the Industrial Dispute Act, 1947"

You might also like