EMPLOYEES’ PROVIDENT FUND ORGANIZATION
Form For Allotment Of Business Number (BN)

2. If the Establishment is already covered then
M H 0 0 1 7 8 3 A
W B S L G 0 0 0 3 8 8
3. Status Ownership Type ( Please Mention exact code from the List Below.)
COMPANY 1 0 PARTNERSHIP 2 0
CO-OPERATIVE SECTOR 3 0 PROPRIETORSHIP 4 0
OTHERS 9 9 TRUST 5 0
(If Others) Please specify
4 Incorporation Setup Details
4a. In case Registered as Factory Factory Licence No.
Licence Date
D D M M Y Y Y Y
Date Of Trail Production
D D M M Y Y Y Y
4b Date of Incorporation Setup
D D M M Y Y Y Y
4c. Place of Incorporation Setup District City
State
Pin-code
(I) Name of The Issuing Authority
(II) Agency Authority Code No.
(III) Date of Issue Expiry Date
D D M M Y Y Y Y D D M M Y Y Y Y
4e. Describe Establishment's prime (In terms of revenue shareor people employed) economic business activity mentioning main product and process
Other Activities
4f.
5. Employee Details (Including all branches,units etc.)
5a. Date on which Employee Strength Exceeded 19 (4 in case of Cinema)
For the first time from the setup incorporation date D D M M Y Y Y Y
5b. Employee Strength on the date of filling this form
5c. Total Wages Paid In Previous Month (In Nearest Rupees)
5d.
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
5e. Is the Establishment Seeking Voluntary Coverage Yes No
5f. If Yes, then date from which coverage is sought
D D M M Y Y Y Y
5h. Reason For Voluntary Coverage
6 Other Supporting Government Codes (If any)
D D M M Y Y Y Y
a. Small Scale Industries Reg. No.
b. IT-PAN as given by the Income Tax Department
c. Employee State Insurance Corporation
d. General Sales Tax No.
e. Central Sales Tax No.
f. EXIM Code No.
g. Excise Dept Reg. No.
h. Custom Dept Reg. No.
I. RBI Registration No.
j. IRDA Reg. No.
k Apparel Export Promotion Council Reg. No.
l Directorate Of Education Reg. No.
m CBSE Reg. No.
n Directorate Of Health Service Reg. No.
o Food Controller Reg. No.
p Drug Controller Reg. No.
q Electricity Connection No.
r Water Connection No.
s Other Government Code
Name Of the Issuing Authority
4d. Please Specify The Supporting Government Code for the Ownership Type
If the exact 5 digit NIC'98 code for your establishment's prime business economic activity is known then please mention it here

Example MH 1783 A should be written as

PLEASE FILL ALL THE FIELDS IN CAPITAL ENGLISH LETTERS USING BLUE BLACK BALL POINT PEN ONLY, FIELDS MARKED ( ) ARE MANDATORY. REFER INSTRUCTION SHEET
FOR GUIDELINES ON FILLING THE FORM
The Establishment Code No.
1. Full name of the establishment factory (as registered with Income Tax department,Registrar of Companies or any other government authority
WB SLG 388 should be written as
(Not For Data Capture) Year
(If Any)
Please mention the employee strength for each month (for previous 36 months)
Code Issue Date