Statement IW - 1
Statement showing the details of Employees qualifying for membership as
International workers
(Under Para 83 of Employees' Provident Funds Scheme, 1952)
[To be submitted immediately after the commencement of the Scheme and along with Form 5 (for unexempted)/ Form 4 PS (for exempted) every month,thereafter]

Name and address of the establishment:
Establishment code no.:
S.No Name I PF Monthly I Nationality and Passport details Remarks
Account Pav 1
• No. . (it; Rs) I Nationality [ Passport No:--Country of Issue : Date of Issue Valid
upto Remarks
International workers under Pam 2 (fi) (a)
International workers under Pam 2 (fi) (b)

Verified
Signature of the employer/ authorised official
Stamp of the establishment
Pay as explained under Para 30 of the EPF Scheme,1952