I think you mean a Non Contributory Period (NCP) Certificate which is otherwise referred to as break in service certificate. There seems to be no prescribed format for declaring NCP days but you can give the details of number of days in each year a particular employee was not paid wages and contribution to EP. The attached is a specimen that you can follow.
From India, Kannur
4245From India, Kannur
Community Support and Knowledge-base on business, career and organisational prospects and issues - Register and Log In to CiteHR and post your query, download formats and be part of a fostered community of professionals.
Expat PF Excluded Employees Contribution & No Due Certificate Clarification.p df