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ELIGIBILITY REGISTER

Name of Factory/Establishment .. Sl. Name of the Employee and Father's Name No. Designation Name of Employee Designation Date of Previous Appointment Days No. of working days rendered month-wise (inclusive of weekly holidays, authorised leave, lay-off etc.
Jan Feb March Apr. May June July Aug. Sept. Oct. Nov. Dec.

HR - 056

Total

Index No.of the declaration in form- 11 (E.P.F.)

Admited to Account Remarks, membership No. if any of the fund Alloted w.e.f.

HR - 055

ARREAR REGISTER FOR THE MONTH OF . . . . . . . . . . . . . .

Sl. Emp. No. Code No.

Name of the Employee/ Arrear Father's Name Month

Arrear Days Month in which Salary Slip No. Paid by Voucher Application Signature of Initial of the Arrear is as per Salary (or) by Salary Number dealing HTK/PPM given Sheet Sheet Time Keeper

HR - 033 (Declaration in FORM No. 25 under Rule 53) 1 Name of the Worker . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 2 Serial No. as in the register of workers under Section 62 of the Act . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Father's Name . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Age and date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Nature of work . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Qualification, if any or period of service on similar work . . . . .. . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 7 Date when tight fitting clothings was provided . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Remarks . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . I certify that the above mentioned worker, whose signature/thumb impression is given below, is a properly trained male adult worker who is competent to mount or ship belts, lubricate or do other adjusting operations on the machinery installed in my factory while they are in motion. Date .. Signature/thumb-impression of worker Signature of Manager/Occupier

MAWANA SUGAR WORKS, MAWANA (A UNIT OF MAWANA SUGARS LIMITED) (Declaration in FORM No. 25 under Rule 53) 1 Name of the Worker . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 2 Serial No. as in the register of workers under Section 62 of the Act . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Father's Name . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Age and date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Nature of work . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Qualification, if any or period of service on similar work . . . . .. . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . 7 Date when tight fitting clothings was provided . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Remarks . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . .. . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . I certify that the above mentioned worker, whose signature/thumb impression is given below, is a properly trained male adult worker who is competent to mount or ship belts, lubricate or do other adjusting operations on the machinery installed in my factory while they are in motion. Date .. Signature/thumb-impression of worker Signature of Manager/Occupier

HR - 032 FAIR PRICE SHOP COUPON ISSUE REGISTER


Month .

Sl. No.

NAME

Father's Name

Designation/ Code

Coupon No. From To

Amount

Employee's Signature

REMARKS

Rs.

ELECTRICITY CHARGES REGISTER


Block No. A/ B/ C/ D/ E

Names Shri. ________________________________ Shri. ________________________________ & _________________________________ _________________________________ Qrs. No. _________________________________ _________________________________ _________________________________ _________________________________

Shri. ________________________________ _________________________________ _________________________________ _______________________________

Date

Total Previous Reading Months Total Reading

Current Charges Months @ 15 P. Net Reading per Unit Rs. P.

Total Reading

Previous Months Total Reading

Current Months Net Reading

Charges @ 15 P. per Unit Rs. P.

Total Previous Current Reading Months Months Total Net Reading Reading

Charges @ 15 P. per Unit Rs. P.

HR-031

Names Shri. ________________________________ Shri. ________________________________ Shri. ________________________________ & _________________________________ _________________________________ _________________________________ Qrs. No. _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ _________________________________

Date

Total Reading

Previous Months Total Reading

Current Charges Total Previous Months @ 15 P. Reading Months Net Reading per Unit Total Reading Rs. P.

Current Charges Months @ 15 P. Net Reading per Unit Rs. P.

Total Previous Reading Months Total Reading

Current Charges Months @ 15 P. Net Reading per Unit Rs. P.

HR-030

Block

Quarter No..

Sl. No.

Code No.

Permanent/ Seasonal

Name of Occupant

Designation

Department Period of Occupation From To

Remarks

Block

Quarter No..

Block

Quarter No..

PAY SHEET REGISTER For the month of 200


Sl. No. NAME Father's Name Designation Attendance Leave (days) w/o P. L. P. R A T E OF PAY Basic D.A. Other Allowance Rs. P. Rs. P. Rs. P. Salary Earned Salary for Linked Insurance Scheme P. Rs. P. House Rent Employees Provident Fund P. Rs. P. Employee Family Pension Scheme Rs. P. Employee P/F Loan

Total

Rs.

P.

Rs.

Rs.

Rs.

P.

HR-029

Fair Price Shop Rs. P.

Canteen Dues

Other

Total Deduction

Salary Paid befire Rs. P.

Net Amount

Rs.

P.

Rs.

P.

Rs.

P.

Rs.

P.

Net Amount Payable after rouding off Rs. P.

Linked Insurance Scheme Rs. P.

Admn. Charges

Signature & Remarks

Rs.

P.

HR-028

Daily Attendance Report for the month of 200 OFFICER


Date On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Temp. SubstiHoliday tute On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

STAFF

WELFARE
On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

CANTEEN, GUEST HOUSE, FAIR PRICE SHOP


On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

SANITATION
On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

SECURITY
On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

ENGG. DEPTT.
On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

PRODUCTION
On Roll Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute Actual on Roll

SUMMARY
Present Accident Sick Leave L.W.P. L.W.O.P. Absent Holiday Weekly Holiday Temp. Substitute

Grand Total

Signature

REMARKS

Form No. 23

(Section 112, Rule 122)


REGISTER OF ACCIDENTS AND DANGEROUS OCCURRENCES
S. Date of No. report in Form 18 to inspector (and notice to insurance authoritaies 1 2 Time Name & Address of of injured person report & notice Sex Age Insurance Shift, Deptt., No. & Occupation of employee Injure of dangerous occurrences Place Cause of injury or Nature of dangerous injury or occurrences dangerous occurrences

Date

Time

What exactly was the injured person doing at the time of injury

10

11

12

13

14

HR-026

Name, occupation address and sig. Or or thumb imp. of the person giving notice

Signature & Name, address Designation and occupation of the person of two witnesses who makes the entry

Date of return Name of of injured person the State to work Insurance Local Office to which the injured person is attached 18 19

Remarks if any

15

16

17

20

Name of the Factory : Serial No. Adult/Child Emp. Code No.

HR-025

Form 14(69)
Department Serial No. in the Register Adult/Child Workers . Date of entry into service ..

(Rule 102)
Name . Father's Name . Date and amount of Payment made in lieu of leave due

LEAVE WITH WAGES REGISTER


Approved : Vide CIF Letteer 10580 F/RGN/Misc/MRT-47 Dated 11.10.63 Year 200

Calender year of service

Wages paid Wages From To earned during the wage period

No. of days worked during the calendar year Total of No. of No. of No. of No. of column days of days of days of days of 4 to 7 work lay off maternity leave performed leave enjoyed

1 January February March April May June July August September October November December Total

Leave to Credit Total of Balance Leave columns of Leave earned 9 &10 from during the preceding year year mentioned in column No. 1 9 10 11

Whether Leave enjoyed Balance of Normal Cash equivalent of Leave in From To Leave to rate of advantage accruing accordance credit wages through concessiowith Scheme nal sale of food grains under Sec.79 and other particulars (8) was refused 12 13 14 15 16

Rate of wages for the leave period (Total of columns 15 & 16) 17

Remarks

18

Name .

REGISTER OF LEAVE/ HOLIDAY Father's Name ...

Date on which leave Applied for Availed Sick From To 1 2 3 4

Nature of leave Casual Previ- Without lege Pay 5 6 7

Absent Date Period From To 8 9 10

Unavailed Balance carried over leave(balance)Remarks Sick Casual Previ- during the lege season 11 12 12 14 15

HR-023

Designation

Date of Joining .

Date on which leave Applied for Availed From To 1 2 3

Sick

Nature of leave Casual Previlege 5 6

Absent Balance carried over Without Date Period Sick Casual PreviPay From To lege 7 8 9 10 11 12 12

Unavailed leave(balance) during the season 14

Remarks

15

HR-020
OFFICERS/STAFF/WORKMEN ATTENDANCE REGISTER FOR THE MONTH OF 200

SERIAL NO.

NAME OF ADULT WORKER FATHER'S NAME

CORRESPONDING TO THAT IN FORM II GROUP OR RELAY SHIFT

10

11

12

13

14

15

16

17

18

19

20

21

22

EMP. CODE DATE OF JOINING P.F. NO. DEPARTMENT NATURE OF WORK

TIME OF COMMENCEMENT OF WORK MONDAY TO FRIDAY SATURDAY SUNDAY

FROM

REST PERIOD TO FROM

TO

TIME OF COMPLETION

23

24

25

26

27

28

29

30

31

TOTAL NO. OF DAYS WORKED

LEAVE WITH PAY

LEAVE WITHOUT PAY

TOTAL DAYS TO PAY

REMARKS

ATTENDANCE REGISTER for the month of

200

Sl. Name of No. S/Shri

Father's Name S/Shri

Designation

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

HR 019

26

27

28

29

30

31

Total Attendance

Leave with pay

Leave without without pay

Total Days to pay

REMARKS

ATTENDANCE REGISTER for the month of

200

Sl. Name of No. S/Shri

Father's Name S/Shri

Designation

Joining Date

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

HR 018

27

28

29 30 31 Total Days

Rate of Basic Wages

Rate of Allowance

Rate of consolidated wages Rs. P.

Amount of wages earned

House Rent

P.F. A/C.

Loan against P.F.

Free Loan

E.P.F.S. Income Fair Tax Price

Canteen D.C.M. Ins.

L.I.C. of India Meerut

Salary & Wages Paid before

Payable Amount

Signature & Remarks

Rs. P.

Rs. P.

Rs. P.

Rs. P.

Rs. P. Rs. P.

Rs. P. Rs. P.

Rs. P. Rs. P.

Rs. P. Rs. P. Rs. P. Rs. P.

Rs. P. Rs. P. Rs. P.

Form No. 12
(Rule 78) Register of Adult Workers under Section 62 of the Act

Time of commencement of work Monday to Friday Saturday Sunday

From

REST PERIOD To From

To

Time of Completion

System of Rotation of Relays

Nature of work

Department

Category

10

Weekly Holiday

Sl. Emp. Name of No. Code Adult Worker

Father's Name

Corresponding to that in Form-II Group Shift of Relay

1st 2nd 3rd 4th 5th 6th 7th 8th 9th

10th

11th

12th

13th

14th 15th 16th 17th

18th 19th

20th 21st

22nd

11

12

13

14 15 16 17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

HR - 017 Department . For the month of 2000

Page No.

23rd 24th

25th 26th 27th

28th

29th 30th 31st Total No. of Days Worked

Rate of Basic Wages

Rate of Allow. if any

Total Hrs. of Overtime

Total

Deductions Under On A/c. InstalP.F. of ment Scheme Advance of LIC

Compulsory Saving Scheme

Actual Wages Payable

Total No. of Weekly Holidays lost by the worker

33

34

35

36

37

38

39

40

41

42

43

44

45

45(a)

45(b)

46

47

48

49

50

51

Date on which compensatory holiday's will be given 52

Remarks or indication showing that the payment have been made together with the dates 53

Fine