o.
ffi qRq fffr si frRs e-dd Bqdq eflEfrqq, 1s52 $ ERr r (+) d do'la
+antqrfu+ fdq €[B-6iqI 6ffid 6r q6ch q,
Consent Letter of Majority of Employees for Voluntary Coverage under Section 1(4)
ofthe Employees' Provident Funds and Miscellaneous Provisions Act' 1952
tqr fr/ro, drfts/Date ....c-tl [Link],n- t .
ffiq qBq / The Regional Provident Fund Commissioner.
lL Pta- l7
EI{q: M ............... ({srq nsrR strd) to) offi .rftq iiB Ki frfru
roH iJqiel erftftqq rgsz al tnn r(+) S [Link] ft-6R ol sdqfA d flar d{i
Sub Extensioo ofEmployees Provident Funds and Miscellaneous Provisions Act, 1952 under Section l(4)
to l\4/s ................ .....
.. (including branches, etc.) -
Consent ofmajority of Employees Regarding
TdI{q / sir,
Eq 3rdr6{<reit +{# ....... (vrercri wFea) $
orMqr 6ffi [Link]. etrq q# sqccl 3lfi'ftqq. 19s2 d 3ir4d i4 t qtfuo ertm
qq qrfu d f q s6qd B defl 6q qr{( rr{fiR a rqe { FrRrn 3IEw{r d sid'ld ql6 an 3ifiq ltE d 3rqi
m 6r qfaq ftff 3isrEn d ..... cftrTd d {i t ti 6} {q6 t t tq qqq ,n ?i t f} sm
f{qq aA atrarrrdrclt of epr sqq t+qq qr srt €YiEr=ii ot qrarc 6fi
we the undersigned majority or employees or Nrs ....C-.4:{-4.7[11.t4ip511|.hf-t...[Link]^rutdlon
(including hanches etc.) do hereby consent and apply to be coveled under the Eflplo\ees Provident Funds and
Miscellaneous Provisions Act, 1952 on voluntary basis with effect frorr- .24.1o.X1.>a2+he last date of the
month in which the notification is published in the Gazette of India, and we are willing to pay our share of
Provident Fund contribution at the rate of .......f-Z-.. % We also undertake lo abide by the requirements ofthe
said statute and the rules framed there under as amended from time to time.
2 6q 3Etq 6{i t fo 6ffi qfte ftff c.i fafaq eoff sq{+1 slffiiqq 1es2 o1 um l(+) d sidfd 3lrds{4
srfr{flrr qaa$, qr0 oG or oe ol t
We request that necessary notification under Section l(4) ofthe Act may be issued at an early date
q.r{iq ,/ Yours faithtully
qFIlName fodr 6r qrql Fathe/s qq fift/ Date of E'RTfl{/ Signature
Sl No name Birth I
G MA.D^JEA I
c-l+rNDRAffi ,or'lo:-fttz
1 NAUT\+U
2
C gI}AK\LA PALAYA/vt o<Joe)rrrr
3
M SUTV\IT}+RA MADlrR.4)
MUT}h-J
22- \r- )gq-r
Page 1 of 4
ffiT r(4) d eic.1n ft{{r{ -*i tg tori d orfi-oirT sffit s6qid q,
(vlft) Consent of majority of Employees of N4/s .......................................for
[Link] under Section I(4) (Continued)
4
M l(ou-eauY4 ,\*DuLS2 c-+loz)Wq .l-'\'{" *-.k
,V\UTVIL,
u
K+t\pL- M*+rlo{(8t.A^ D?'lor l*o,
4(^,".J
6
RnJeswn€s_
A A D\en€Ar\l
MONoK.e<n{v ra/4rre, Qant2t'*"
7
l'1oHerurum+e MADURA\MI'II' o z<fr-frrt M"t"'^\"g
NFNDHIN I VEI_U rsloqlrtt P'Dil_-
t\
o
NATlilYA<ueEt ,H Vr-.t:s -4 o-7 11e1
10
AsttoKxunnRe \QftMFMuErtiy ou
)us)rre.,
1'l
12
13
14
15
16
17
'18
'19
# put additional sheets if so required
Frdm em *rymfto
Counter Signed by Employer
Page 2 ol 4
ffif d sdqfr Consent of Employer
eq
f,,2 M
d Erff,i d qrvq* t iici6
FrArr4,/'[Link]<R, q1ro qr6 d 3iidq ft-c 6l qq 3tBq{{r rnrRld
[Link], i offi qfaq ftfu Bi ftfttr r+H sc{+r 3TBfiqq 61 tns r(+) d Gir.l( {tfu6 errm qr qftr d
ftc arrt{r 6{d tt q,/Eq Frdr-q+ d sq t rs erDftqq o1 ercr 6 (erT 6 d tEffi qfrq ffi ri1-qqt, 1e52 $
t{ zg G:e <el offi trm frsrT rgss, firfr t{r 28 3s apn 6fft qfrq ftB q}sli rssz d i{ qm ss
gi
\.s as d 3i fu qQrrdal [Link]( d €rer q.6r Rrf, d ili rlE [Link] gtarrFr fu-qi .rq t t
qFdYK ttt qq
t rftq ftB dqn iiyrq fiB 3iyl{l{ d tt/Eqt M or [Link] rri or gragrtT tr{r At t npn w{q q{q q{
aqr rjqtDa qifrfuF Trn ssd tra ffiE .T{ Fqq} d s,.t qrqtrit oer srd or qroc 6-{A tt
vwc.. .. . .. . .. .. .C. ..|v\.AD. [Link].T. tlu. for the
Propri€tor/DirectorPartner of lr4/s. .C .M-RDUR+.1.{Y)!r J.. .CoNSfPU(fiUfu*by apply for coverage
under Section l(4) of lhe Employees' Plror ident Funds ard Miscellaneous Provision Acr. lq52 on voluntary
basis \airh effecr from......3{..[ o:I..[Link]:J....rt" lasl dare of the monlh in which the Norification is
published in lhe CaTene of India. I/We. as employe(s). do hereb; undenake Lo and will pay my/our share of
Provident Fund and Pension Fund cont bution at the rate of .............7o, as provided under Section 6 and 64
ofthe said Act read with paragaph 29 and 38 ofEmployees' Provident Funds Scheme, 1952 and paragraph 4 of
Employees' Pension Scheme.l995 and Administrative charges as provided under paragraphs 38 and 39 of
Employees' Provident Funds Scheme.l952 and to abide by all provisions and requirements of the said status
and the rules liame there under as amended hom time to time.
3lts-srFr sffi ci$flq d sqi fi€ qFdrd d <* i
2. [Link]< 6{i d fla! gq6 t oen otrarfi
qfdq ftB gq r+ff sqoq s€fiqq dQn ssd ffn qrri ri dffi{r A glq+r} d GEqrfi trG d ftI
{{rcd B t w ririu ii s{o1 fAfu.d s6qff rid{c t r
The majority of the employees are willing to pay their shares of contributions at the rate of .......... Yo and
have agreed to comply with the provisions ofthe Employees' Provident Funds and Miscellaneous Provisions
Act. 1952 and the Scheme framed there under. The written consent to this effect is enclosed.
3. t/Eq ffis{ d tq t tq qra o'ri d fo aq offi frdc e.f,c-{ frqr d'wrr. rszo S 3iyrcri o} sm f+qq
ol qr(] 6 (.T). ffit wn dq d t{r z S {{ietr qdl TrrT t, A ffn op,n sfiafuo o.s qf}yrd a1 qltftn
dqqr 6 Dn : d strfr den fuor ry1 tt cqTfr'o qqn [Link] o1 <s Q gr]nln ott oerT qlff qrcuFt s
3ns{qtEdT3it, rifrfio ep.n sqq qs s$d sffi qrTc ry fi+dl or rror olt
I/We, as employer(s) do hereby undertake to and will pay the Employees' Deposit Linked Insurance
Scheme. 1976 Contributions at the rate of0.5% as provided under Section 6C of the said Act read with
paragraph 7 of the said Scheme and Administrative Charges at the rate of 0.017o as provided under
paragraph 3 of the Scheme and to abide by all provisions and requirements and the statute and the rules
framed there under ftom time to time.
ff./Eq q6 fi enssrcc tA t fu offi
4. 'rEq fifu Ei fafatl r+H sqdr+r ofiftqq. rszo d Iiid+d F-Trg
.Tg
d-sir d sr$r drfi of it,/Eqrt srq yn€rst,/6EffiiZoffiiZqroiZflqmf/dftrd n orfud
offiii d cand r sw sfiafua €terrqi t FrdPdrd or&-crdq rs$ i fr ga afqrR-qt A 3rM{r
waqfr fl tr
VWe, also undertake and agree to extend the benefits under the Scheme framed under the Employees'
Provident Funds and Miscellaneous Provisions Act, 1952 to the employees employed in my/our other
brancheVoffices/units/departments/factories. The majority of the workers employed in the above mentioned
concerns have also subscribed to the "consenf' by the majority oftotal employees.
r T$/Eri Fqiqqt (oi) d sq n qqqd d !!i{Tsl-r o1 ({ sfr{ra }i ,} ftr +i{ crnft +€i f, ,rr
{,/Eq 6falt qfdq BB drq+, rssz d tn ge offiI fq*q sr d< ffqT ttrsfl. rsza d trT a [Link]
Trrq-qqq q{ ffiq sron dRT n..n fuiftd ena{q.F lcr[qfto JrTrqt d UrFrr 6e ol lM dd t I
UWe, as employer(s) have no objection to the workers, contribution at the rate of............\2*........... %
and I/We, undertake to pay the necessary adminishative charges as fixed by the Central Government from
time to time under paragraph 39 ofthe Employees' Provident Funds Scheme, 1952 and paragraph 8 ofthe
Employees' Deposit Linked lnsurance Scheme, I976.
Page 3 of4
6 d-*q qfle ffi eirgm d am eiffBs{ +1 tim l(+) d c;o.l( 3'rsgr6 gfir|a{r srS F{i d fir g-rdP{f,
tmq€n 6t t
NecessaryArrangementsmaykindlybemadetoissuethenecessarynotificationunderSectionl(4)ofthe
Act. hy the Central Providenl Fund Commissioner'
seal t"{{lq/Yours faithtully
FrdrscF (d) 6T FfnlaN/ Signature olEmployer(s)
C,
Page 4 of 4
