[Company Logo][Company Name]
- Ref. No.:
- [Reference Number]
- Date:
- [Date]
- Financial Year:
- [FY YYYY-YY]
- Employee Name:
- [Employee Name]
- Employee ID:
- [Employee ID]
- Designation / Department:
- [Designation] / [Department]
- Date of Joining:
- [Date of Joining]
- UAN:
- [UAN]
Dear [Employee Name],
This statement summarises the total amount [Company Name] invested in your employment during the financial year [FY YYYY-YY]. It includes cash salary as well as contributions and benefits that do not appear in your monthly in-hand pay.
Part A – Salary Paid
| Component | Approved Annual (₹) | Actual Paid (₹) |
|---|
| Basic Salary | [Amount] | [Amount] |
| House Rent Allowance | [Amount] | [Amount] |
| Special Allowance | [Amount] | [Amount] |
| Other Allowances | [Amount] | [Amount] |
| Bonus / Incentives Paid | [Amount] | [Amount] |
| Arrears Paid | [Amount] | [Amount] |
| Total Salary Paid (A) | [Amount] | [Amount] |
Part B – Employer Statutory Contributions
| Component | Approved Annual (₹) | Actual (₹) |
|---|
| Employer PF (EPF + EPS) | [Amount] | [Amount] |
| Employer ESI (if covered) | [Amount] | [Amount] |
| Gratuity Provision | [Amount] | [Amount] |
| Labour Welfare Fund (employer share, if applicable) | [Amount] | [Amount] |
| Total Contributions (B) | [Amount] | [Amount] |