Amendment status not verified — confirm the current text below against the official source.
No.of workers covered under EDF 14 No. of workers covered under ESI 15 Details of Gratuity 16 Details of Bonus paid 17 Details of Employees Compensation paid 18 Leave eligibility 19 Details of payment of maternity benefit 20 Details of weekly off & other holidays allowed 21 Details of Welfare fund contribution 22 Details of settlements / Strikes/Lock-outs/Lay-offs/ Retrenchments closures etc. 23 Whether Works Committee constituted 24 Details of Trade Union existing in the establishment /industry 25 Details of contractors under Contract Labour Act 26 Details of contractors under Inter State Migrant Workmen Act 27 Whether muster roll, wages register etc, maintained 28 Whether appointment letters/Identity cards issued 29 Details of building or other construction work 30 Note:- Combined Annual Return for the ending 31 March shall be furnished online before 30th June of the following year DECLARATION I/we hereby declare that /we have complied with all relevant provisions of the Labour Act applicable to the establishment. In the case the information furnished above is found to be false, misrepresented or suppressed any material information or evaded to furnish the information, I/we are liable for prosecution as per law besides cancellation of the registration /license granted. Signature of the Employer Date Place Name & Designation of the Employer 9 ANNEXURE-I STATEMENT SHOWING CATEGORY WISE DETAILS OF WORKERS Establishment category/ worker category Direct workers Contract workers (contract labour act) Inter State migrant workers/ (Inter State workmen Act) Casual workers Seasonal workers Badli Workers Apprentice Others (Specify the category) Male Female Male Female Male Female Male Female Male Female Male Female Male Female Male Female Employees in shops (AP Shops & Estts. Act) Employees in Establishments (AP Shops & Essts Act) Employed in Factories Building and other construction Workers Sales promotion employees Plantation workers Beedi/ Cigar Workers Any other category worker/ Establishment (specify name 10 ANNEXURE-2 STATEMENT OF DETAILS OF WAGES, BONUS PAID TO THE WORKERS DURING THE YEAR Sl. No Name of the worker Gender Establishment category (as vertical column in Annexure.1) Worker category (as specified in horizontal column in Annexure. 1) Designation Length of service Staff code No/Staff No/ Token No. EPF No. ESIC No DETAILS OF WAGES PAID PER MONTH Amount of bonus paid for the previous accounting year Whether covered under gratuity insurance scheme Basic wage VDA All other allowance Total wages (gross) Deduction Net wages paid 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 11 GOVERNMENT OF ANDHRA PRADESH LABOUR DEPARTMENT FORM-C CERTIFICATE OF REGISTRATION / LICENSE OF ESTABLISHMENT – Sec. 2(d) and 4(2) The Andhra Pradesh (Issuance of Integrated Registration and Furnishing of Combined Returns under various Labour Laws by certain Establishments) Act, 2015