Application for approval of superannuation fund or gratuity fund

Part-A

1.

Details of the Employer:

(i)

Name

(refer note 1)

(ii)

Address

(refer note 2)

(iii)

Permanent Account Number

(iv)

Business/Profession

(v)

Principal Place of Business

(refer note 2)

Part-B

2.

Details of the Fund

(i)

Name

(refer note 1)

(ii)

Permanent Account Number

(iii)

Date of creation

dd-mm-yyyy

(iv)

Type of fund

(select one)

(i) Superannuation fund or part thereof

(ii) Gratuity Fund

3.

Classes and Number of Employees Entitled to Benefits of the Fund:

(i)

In India

Sl.No.

Class of

employee

Number of

Employees

(ii)

Outside India

Sl.No.

Class of

employee

Number of

Employees

4.

Place where the accounts of the fund are or will be maintained

(refer note 2)

5.

If the fund is already in existence, details relevant to the financial year ending prior to the date of application:

(i)

total corpus of the fund

(ii)

investment pattern being followed

[give breakup in accordance with the

investment pattern prescribed in rule 303 or 318 as applicable]

6.

Other details to be provided as separate enclosure

(Attach as per note 3)

I/we, the trustee(s) of the above fund, apply for approval of the fund or part thereof under Paragraph 4(1) and 4(2) of Part B of Schedule XI to the Act.

Signature:

FORM OF VERIFICATION

I/we, the trustee(s) of the above fund, do declare that what is stated in the above application is true to the best of our/my information and belief, and that the documents enclosed herewith are true copies of the original

Date: Signature:

Annexure

Particulars

A-1

Copy of the instrument establishing the fund

A-2

Copy of the rules of the fund

A-3

Copy of the accounts of the fund relating to such earlier year or years (not more than three years immediately preceding the financial year in which the said application is made) for which the

accounts have been made up, if the fund has been in existence before the financial year in which the application for approval is made.

A-4

Copy of the Balance sheet of the fund as on 31st March of the financial year preceding the date of Application, if the fund is already in existence.