FORM NO-9 (REVISED)
THE EMPLOYEES’ PROVIDENT FUNDS SCHEME, 1952 (PARA 36(1)) AND THE EMPLOYEES’ PENSION SCHEME, 1995 (PARA 20)
(PARA 16(1) RETURN OF EMPLOYEES WHO ARE ENTITLED AND REQUIRED TO BECOME MEMBERS OF THE EMPLOYEES’ PROVIDENT FUND AND PENSION FUND (GUJARAT REGION)

Name and Address of Fact/Estt. Code No. GJ/
Date of Coverage
Industry in which the Fact. / Estt. If factory / Estt. Is covered under
is engaged ESI. Act. Indicate the Code No. allotted under E.S.I.C.
E.S.I. Code No.____________
Sr.
No
Account No. GJ/
Name of employee (in block capital)
Father’s Name (or husband’s name in case of married women
Date Of Birth
Sex
Date of eligibility for membership
Total period of previous service (Excluding period of break) as on date of joining the fund
Machine/Folio No of Ledger Card Opened
Initials of S.S.
Date and reason of living service
D.C. S.S. A.A.O. / A.C.
Remarks and Initial on settlement
1
2
3
4
5
6
7
8
9
10
11
12