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Union of India - Section

Section 12th in Employees' State Insurance (General) Regulations, 1950

12th. May/11th November*

Name opf Branch Office............................Employer's Code No...................RETURN OF CONTRIBUTIONS(Regulation 26)EMPLOYEES'STATE INSURANCE CORPORATIONName and address of the factory or establishment:........................................................Particulars of the principal employer(S):...........................................................
(a)Name...............................................................
(b)Designation:.......................................................
(c)Residential address:...............................................
Contribution period:From...................................to..........................I furnish below the details of the employer's and employee's share of contributions in respect of the undermentioned insured persons. I hereby declare that the return includes each and every employee, employed directly or through an immediate employer or in connection with the work of the factory/establishment of any work connected with the administration of the factory/establishment or purcahse of req materials, sale or distribution of finished products, etc., to whom the ESI Act, 1948 applies, in the contribution period to which this return relates and that the contributions in respect of employer's and employee's share have been correctly paid in accordance with the provisions of the Act and Regulations.Employee's Share.........................................Employer's Share.........................................Total contribution.......................................
Sl.No. Month Date of Challan Amount Name of the Bank and Branch
1.        
2.        
3.        
4.        
5.        
6.        
Total amount paid:Rs....................................Place..............................Date......................................................................................Signature and Designation of the Employer(With Rubber Stamp)Important Instructions-Information to be given in "Remarks Column (No. 9)".
(i)If any L.P. is appointed for the first time and/or leaves during the contribution period indicate "A.......................................(date)" or "L.....................(date)".
(ii)Please indicate Insurance Nos. in ascending order.
(iii)Figures in Columns 4,5 and 6 shall be in respect of wage period ended during the contribution period.
(iv). Invariably strike totals of Columns 4, 5 and 6 of the Return.
(v)No overwriting shall be made. Any corrections, if made, should be signed by the employer.
(vi)Every page of this Return should bear full signature and rubber stamp of the employer.
(vii). Daily wages in Column 7 of the return shall be calculated by dividing figures in Column 5 by figures in Column 4 to two decimal places.
For *CP ending 31st March, due date is 12th MayFor CP ending 30th September, due date is 11th NovemberEMPLOYEES'STATE INSURANCE CORPORATIONEmployer's Name and Address............................................................................Employer's Code No...................................Period From..................to............................
Sl.No. Insurance Number Name of insured person No.of days for which wages paid Total amount of wages paid (Rs.) Employee's contribution deducted (Rs.) Average daily wages(Rs.) Whether still continues working Remarks
(1) (2) (3) (4) (5) (6) (7) (8)  
                 
                 
                 
                 
                 
                 
                 
    Total            
*Date of appointment and leaving the job may be given in remarks column........................................................Signature of the Employer(FOR OFFICIAL USE)