FORM 7 [IF]

For use by Establishment Exempted from the Provisions of E.D.L.I. Scheme 1976, under section 17(2A) of the Employees Provident Fund and Misc. Provisions Act, 1952. Monthly Return to be made by Establishment Exempted under Section 17(2A) of the Employees Provident Fund and Misc. Provisions Act, 1952 for the month of _____________________. Name of the Establishment : Code No.: 1. SUBSCRIBERS A. No of employees covered under the scheme on the last date of the previous month. : B. No of employees covered during the month. C. No of employees left service during the month on account of cessation of employment. : D. No of covered employees on the last day of the month. : E. Total no of employees in the establishment on the last date of the month. : 2. INITIAL ACCUMULATIONS

I] Accumulation prior to the commencement of the Act. a) Total amount of accumulation prior to the commencement of the EDLI Scheme, 1976. : b) Amount invested out of [a]. : c) Balance remaining un-invested as on the date of applicability. : d) Amt. transferred to securities and cash to the Board of Trustees & the date of transfer : e) Balance. : II] a) Employer's contribution from the date of application of the EDLI Scheme, 1976 to the preceding month : b) Amount transferred to the Board of Trustees and the date of transfer : c) Balance. :

3. WAGES & CURRENT CONTRIBUTION I] Total amount of gross wages liable to E.D.L.I. contributions : (Basic wages, D.A., retaining allowance, if any, and cash value of food concessions Admissible thereon)

II] a. Current employer's contributions (during the month of). : b. Amount of contribution transferred to the Board of Trustees and date of transfer. : c. Balance. : d. Total Balance indicating total arrears of E.D.L.I. dues transferable to the Board (2 (I) (c) +2 (II)(c)+3(II) (c) :

4. Other income during the month (Interest on investments). : 5. PAYMENTS a) Total amount of premium payable for the year by the estt. in respect of employees covered under the
scheme :

b) Total amount paid as premium of for the year with dates of payments. : c) Total number of cases of death on members occurred in the month and the amounts payable as ins.
benefits : :

d) Total amounts paid as assurance benefits during the month

Number of cases involved __NIL____Amount paid_____NIL_____Date of payments_____N.A._________ e) Date of expiry of Assuanecpolicies, if any with details :

6. AMOUNT AVAILABLE FOR INVESTMENT

: (II) (a) : [c] Amount specified against item no. 4 [d] Total of (I),(II) & (III) :

[a] Un-invested amount brought forward from the preceding month [b] Amount specified against item

[e] Less amount specified against item 5 [f] Net amount available for investment (IV-V) : [g] Amount invested during the month and date of investment : [h]Amount lying un-invested at the end of the month (VI-VII) : 7. INVESTMENT DURING THE MONTH :

[a] Central Government Securities [b] State Government Securities. : [c] Other securities guaranteed by the Central or the state Govt. [d] Post Office Time Deposit. : [e] Special Deposits. [e] Total (a+b+c+d). : Note: The aggregate of (a to e) should tally with the amount specified against item 6(VII) 8. INSPECTION CHARGES A. Past dues, if any. B. Dues for the month. : C. Amount paid. : D. Date of payment. E. Balance to be paid. : Date: : :