Name of The Establishment______________________________________________

Sr.No. 1

Name of the Employees 2

Whether he has Completed 15 years of age at the Father's Name / starting of accounting Husband's Name Year. 3 4 YES (ABOVE 15 YEARS)

Form C Rule 4

Payment of Bonus Rules, 19

Bonus paid to Employees For the Accounting Year ending on __________________

_____________________
Amount of Bonus Total Salary or payable Pooja Bonus or No. Of Days Wages in respect under S.10 or other customary Interim Bonus or worked in of the accounting 11 as the Bonus paid Bonus paid in Designation the year year case may be during the year Advance 5 6 7 8 9 10 TRAINEE 278 43000 3500 NIL NIL

Bonus Rules, 1975

No. Of Working days in the Year___________________

Deductions on a/c of Financial loss if any on a/c of misconduct of the employee 11 NIL

Total Sum Deducted 9+10+11 12 NIL

Net Payment Amount Date on Which Payable actully paid paid 13 14 15 3500 3500 Oct-10

Signature / Thumbs impression of the Employee 16

Leave With Wgaes Reg

Name of the Worker..
Ticket No.. Occupation..

Name of the Factory

Department..

No. of Days worked during the Calender Year No.of days Leave with Wages Enjoyed No.Of days of layoff No. Of days Work Performed

Leave with wages

No.of days of Maternity leave with wages

Month

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

26

Total 26

Year

e With Wgaes Register

FORM NO. 20 ( See Rule 105)

DISCHARGED WORKER Date Date and amont of payment made in lieu of leave with Register Remarks

Father's Name .. Normal Rate of Wages. Page No. - Old / New Sr.No. From Adult/ Children Register Date of Entry into Service

Leave with wages to Credit Whether Leave with wages not desired during the next Year Whether Leave with wages refused Leave with Wages earned during this Year Balance of Leave with wages from preceding year

Leave With Wages Enjoyed Balance to credit 11.3

From

Total

10

1.3

11.3 NO

NO

NO

NO

To

DISCHARGED WORKER

Date and amont of payment made in lieu of leave with

Normal rate of wages

Cash equivalent or accuring through concessional sale of foodgrain or other articles

Rate of wages for leave wages period

FO

(see

Registe
Name and adress of Contractor

Nature and Location of Work

Sr.No. 1

Name of Workmen 2 DINESHKUMAR PATIL

Father's / Husband's Name 02 3 BHARAT

Sex

Designation and department

Date on which overtime work was put in 6

4 5 MALE HR EXECUTIVE

FORM XIX
(see rule 59 (2) (e)

Register of Overtime
Name and address of Establishment in/ under which Contract is carried on :-

Nature and address of Principal Employer

Wages of Overtime On Each Occasion 7 Total Overtime Worked or production in case of Normal piece- rates Hours 8 9

Normal rates 10

Overtime Normal Overtime Total rate earnings earnings earnings 11 12 13 14

s of Establishment in/ ract is carried on :-

ss of Principal Employer
Innitials of contractor or his representative 16 Initials of Authorised Representative or Principal Employer 17

Date on which overtime work was put in 15

Register of Deduction for D

Name and address of Contractor_______________________

Nature and location of work

________________________

Sr. No. 1

Name of Workmen 2

Father's Name / Husband's Name 3

Designation 4

Perticulars of Damage or Loss 5

FORM XVI
[ See Rule 59 (2) (d)

ster of Deduction for Damage or Loss

Name and address of establishment in/ under which contract is carried _________________________________ Name of the Principal Employer _________________________________

Date of Damage or Loss 6

Wheter Worker cause against Deduction 7

Name of the person in whose presence Amount of employee's explanation Deduction was heard imposed 8 9

Date of No. Of First Installment Installment 10 11

_______________________

_______________________

Recovery of Last Installmen 12 Signature of the Employer or His Representative 14

Remarks 13

Name and address of Contractor

_____________________

Name and address of establishment in/ under which contract is carried on _____________________

Sr.No. 1

Act / Ommission Father's / Husband's for which fine Name of Workman Name Designation imposed 2 3 4 5

FORM XVII
[ See rule 59 (2) (d)

Register of Fine
Nature and location of work _________________________________

Name and address of principal Employer_______________________

Date of Offence 6

Whether employee Showed cause 7

Name of person in whose presence employee's explanation was heard 8

Rate of wages 9

Amount of fine imposed 10

Date on which fine imposed 11

Remarks 12

Maternity Ben
Name of The Establishment : Nature of the Establishment :

Sr.No. 1

Name of the Women 2

Date Of Appointment Dept. 3 4

Nature of Work 5

Dates on which she is laid off and not employed 6

Form X
[See rule 12(1) ]

Maternity Benefit Register

Date on which woman Total days gives emploed payment in the period 7 8

Date of birth of child 9

Date of production of proof of pregnancy under S.6 of the Act. 10

Date on which Maternity Date of Benefit is production of paid in proof of advance Delivary/ and the Miscarriage / amount Death thereof 11 12

Date on which subseque nt payment of maternity benefit is made 13

Date on which medical bonus is paid and amount thereof 14

Date on which wages on account of leave paid and amount thereof 15

If Woman dies and child survives, If women the name dies Date of the of Death, person to Name of Name of whom the person to maternity person whom benefit is nominated Maternity paid on by the benefit is behalf of women paid. child 16 17 18

Remarks Columns for the use of Inspector 19

FORM ' A'

[ See rule 4 ]

Name of the Industry Name Of Employer Address Month and Year to which the House rent allowance Relates

: : :

Sr.No 1

Name of Workman 2

Wages for the Month for which House - Rent House - Rent allowance is payable allowance paid 3 4

This is to certify that I have today in the presence of witness testifying herewith paid the amount of Rs.. In hous the workmen employed by me and that each workmen employed by me and that each workman has received the amount of ho Specified agianest his name above. Witnesses 1.________________________

2.________________________

Mode of Payment 5

Signature of Workmen 6

Remarks 7

with paid the amount of Rs.. In house-rent allowance to ach workman has received the amount of house - rent allowance

Signature of Employer

FORM 'I'
[ See Rule 12 ]

Register of Workmen
Name of The Establishment : Address Nature of Industry

Sr.No. 1

Name of Workmen 2

Date of Appointment 3

Designation 4

Basic 5

D.A. 6

Signature of The Employ

Total 7

Amount of H.R.A. Paid 8

Signature of Workman 9

Signature of The Employer

FORM XVIII
( See rule 59 (2) (d)

Register of Advance
Name & address of Contractor_________________ Nature Location of Work______________________

Sr.No. 1

Name Of Workmen 2

Father's Name / Husband's Name 3

Nature of Employment 4

ORM XVIII

See rule 59 (2) (d)

er of Advance
Name & address of establishment__________________ Name & address of Principal Employer______________

Earning During a Wage period 5

Date and Amount of Advance 6

Purpose (s) for Amount of Installment which No. of installment repaid with date of Advance is by which Advance postponement made is repaid granted 7 8 9

Signature or Date on which total thumb impression amount paid of the worker 10 11