Printed from www.taxmann.com FORM NO. 41 [See rule 74] Form for maintaining accounts of subscribers to a recognised provident fund Name __________________________________ Date of joining fund ____________ Account closed _____________ Date ______________________ Paid to employee __________________ Lapsed to employer or to fund ____________ Recovery by employer _____________________ Contributions Year and month Salary Amount transferred from any other recognised provident fund Contributions by employee Regular contributions by employer Employer's contribution of a contingent nature Total of cols. 3, 4, 5 and 6 Total interest on col. 7 1 2 3 4 5 6 7 8 * Balance brought forward April May June July August September October November December January February March Total Adjustment on account of temporary withdrawals account (columns 9, 10 and 11 only) Adjustment on account of non- repayable withdrawals account (columns 12, 13 and 14) Total carried over Printed from www.taxmann.com Exempt Not exempt Year and month Contribution by employer not exceeding 10% of salary for the year Interest on sums in col. 7 not in excess of 1/3rd of salary for the year and allowed at the rate not exceeding ... % Employee's contribution not exceeding 1/5th of salary for the year or Rs. 8,000, whichever is less 5 + 6-9 8-10 4-11 Additions to total income (cols. 12 and 13) Amount on which abatement is to be allowed (col. 11) Remarks 1 9 10 11 12 13 14 15 16 17 Balance brought forward April May June July August September October November December January February March Total Adjustment on account of temporary withdrawals account (columns 9, 10 and 11 only) Adjustment on account of non- repayable withdrawal account (columns 12, 13 and 14) Total carried over NON-REPAYABLE WITHDRAWALS ACCOUNT TEMPORARY WITHDRAWALS ACCOUNT Amount Advance Repayment Interest Balance brought forward April April May May June June July July Printed from www.taxmann.com August August September September October October November November December December January January February February March March Total Balance carried over *If desired, column 8 may be divided into sub-columns to show separately the interest on column 3, column 4 and columns 5 and 6, respectively.
