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 employe e (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/Foli o 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
