FORM No 5A Date : 26-Mar-2025
EMPLOYEES' PROVIDENT FUND SCHEME 1952 (Please refer Para 36A)
EMPLOYEES' PENSION SCHEME 1995 (Please refer Para )
EMPLOYEES' DEPOSIT LINKED INSURANCE SCHEME1976 (Please refer Para
(Ist RETURN OF OWNERSHIP AFTER ONLINE APPLICATION FOR CODE NUMBER)
[THIS FORM 5A HAS BEEN GENERATED BY ONLINE FILLING/ UPDATION OF FORM 5A THROUGH ECR LOGIN
OF EMPLOYER. APPLICATION NUMBER IS 10000643245.]
Code Number : MRNOI2364776000
1. Name of Establishment : CREATONS INDUSTRIES PRIVATE LIMITED
2. Code Number of the Establishment under EPF Scheme : MRNOI2364776000
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3. Postal address of the Establishment and : A-37, Sector-63,, null, Noida, GAUTAM BUDDHA NAGAR, UTTAR
its branches [Please see Annexure PRADESH - 201307
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4. Industry or business in which engaged : OTHERS
5. Date of commencement of business : 30/04/2021
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6. Date of closure by previous : N/A
7. Whether run by owner or lessee : Run by Owner
8. Particulars of owners :
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S. Name Date of Status Father's Name Residential Position
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No. Birth Address Date
1 Ms. LAKSHMI GOYAL 31/03/1984 DIRECTOR IYER OC-2, 1803, NEAR 30/04/2021
SHIPRA MALL,ORANGE
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COUNTY,
INDIRAPURAM, I.E.
SAHIBABAD,GHAZIABA
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D,INDIA,UTTAR
PRADESH,,201010,
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2 Mr. GITA RANI 10/05/1959 DIRECTOR ATAM PRAKASH 101, AASHIANA 30/04/2021
GOYAL GUPTA LUXERIES, 214-
A,SAKET,MEERUT,INDIA
,UTTAR
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PRADESH,,250001,
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3 Mr. VARUN GOYAL 09/10/1981 DIRECTOR TRIBHUVAN KUMAR OC-2, 1803, NEAR 30/04/2021
GOYAL SHIPRA MALL, ORANGE
COUNTY,NDIRAPURAM,
I.E.
SAHIBABAD,GHAZIABA
D,INDIA,UTTAR
PRADESH,,201010,
9. In case on lease, particulars of lessee : N/A
S.No. Name Date of Birth Father's Name Residential Address Position
Date
10. If registered under Factories Act, particulars of Manager or : N/A
Application Number : 10000643245 Page 1 of 5
Code Number : MRNOI2364776000
11. Particulars of persons mentioned above who are incharge and responsible for conduct of business of the
S. Name Date of Status Father's Name Residential Position
No. Birth Address Date
1 Mr. VARUN GOYAL 09/10/1981 DIRECTOR TRIBHUVAN KUMAR OC-2, 1803, NEAR 30/04/2021
GOYAL SHIPRA MALL, ORANGE
COUNTY,NDIRAPURAM,
I.E.
SAHIBABAD,GHAZIABA
D,INDIA,UTTAR
PRADESH,,201010,
Date:
ANNEXURE - I
Details of Branches of the Establishment
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ANNEXURE - II
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List of Branches having Separate/ Sub Code Number
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ANNEXURE - III
Details of Bank Account Number
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No. IFSC CODE BANK NAME BRANCH NAME ACCOUNT NO ACCOUNT TYPE PRIMARY
ACCOUNT
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1 UTIB0003431 AXIS BANK SECTOR SEVENTY 921020018561591 CURRENT YES
EIGHT NOIDA
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Copy of cheque of the primary account number : 921020018561591
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Application Number : 10000643245 Page 2 of 5
Code Number : MRNOI2364776000
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Application Number : 10000643245 Page 3 of 5
Code Number : MRNOI2364776000
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Application Number : 10000643245 Page 4 of 5
Code Number : MRNOI2364776000
SPECIMEN SIGNATURE CARD
To be submitted with all documents after the Code number is allotted through the online application.
FULL NAME OF THE AUTHORISED SIGNATORY __________________________________________________
Name of Establishment : CREATONS INDUSTRIES PRIVATE LIMITED
Address of the Establishment : A-37, Sector-63,, null, Noida, GAUTAM BUDDHA NAGAR, UTTAR PRADESH - 201307
Code Number of the : MRNOI2364776000
STATUS OF THE SIGNATORY : # EMPLOYER / AUTHORISED SIGNATORY
# Strike whichever is not applicable
SPECIMEN SIGNATURE 1. _____________________________
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2. _____________________________
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3. _____________________________
SPECIAL INSTRUCTION, IF ANY _______________________________________________________
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SPECIMEN SIGNATURE OF Mr/Ms _______________________________________________________ ATTESTED
Signature of employer _____________________________
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Name of Employer _____________________________
Designation of Employer _____________________________
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Seal of Establishment Mobile number _____________________________
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[ ] Please tick if "Not Applicable" due to upload of digital signature
To be submitted separately for each Authorised Officer, if more than one.
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Not to be submitted in this format if the employer after allotment of code number has uploaded digital signatures of the
Authorised signatories.
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In such case the letter generated from the portal after uploading the digital signature(s) to be sent.
In case of upload of digital signature, when page (6) specimen signature card is not applicable, strike this, but keep as
enclosure to the form 5A.
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Application Number : 10000643245 Page 5 of 5
Code Number : MRNOI2364776000
