Amendment status not verified — confirm the current text below against the official source.
Column 7 to be filled up on each working day and the remaining columns to be completed within seven days of the expiry of the wage period. Signature of the employer with full name in capitals. Date……………………… Place……………………… Serial Number Name of the employee Date of employment Permanent address Age or date of birth Father‟s or husband‟s name For the period ending ____ Number of units of work done during ____ Total attendance 1 2 3 4 5 6 7 8 10 FORM D [See section 4 (1) proviso (b) (i)] MONTHLY REGISTER SHOWING WELFARE AMENITIES TO BE MAINTAINED BY SMALL ESTABLISHMENTS Name and address of the employer_________________ Address of the establishment: Local/ Permanent For the month of________________ Whether Welfare Amenities provided for Whether Scheduled Caste/Scheduled Tribe, Handicapped, or any other particular category Signature of the employer or his agent Remarks of the Inspecting Officer Signature of Inspector with date Rest room Drinking water First aid 10 11 12 13 14 15 16 Note: To be completed within seven days of the expiry of each calendar month. Signature of the employer with full name in capitals. Date……………………… Place……………………… Serial Number Name of the employee Sex Designation Weekly day of rest Dates of holidays for festivals or similar other occasions Number of casual leave availed by the employee Quantum of annual leave with wages Due Availed 1 2 3 4 5 6 7 8 9 11 FORM E [See section 4 (1) proviso (b) (ii)] MONTHLY REGISTER OF MUSTER ROLL-CUM-WAGES REQUIRED TO BE MAINTAINED BY VERY SMALL ESTABLISHMENTS Year_________________ Month______________ or Wage period (where different)________ Name of establishment___________________________________________________ Name of employee__________________________ Father‟s Name________________________ Nature of work_____________________________ Rate of wages________________________ Wage period_______________________________ Date of employment___________________ Date Hours of work Interval for Rest and Meal Hours worked with the employer Overtime Casual or sickness leave availed during the month/wage period From To From To Hours worked Wages earned 1 2 3 4 5 6 7 8 9 Note: Columns 1 to 12 to be filled up on each working day and the remaining columns to be completed within seven days of the expiry of the wage period. Signature of the employer with full name in capitals. Date……………………… Place……………………… Privilege Leave Signature of the employer Remarks of the employer Remuneration Due Leave Due Leave availed Balance Basic salary or wage Overtime Other allowances, if any Total 10 11 12 13 14 15 16 17 18 Deductions Net amount of payment Date of payment Signature or thumb impression of the employee Signature of Inspector with remarks, if any, and date Fines and deductions on account of damage or loss by neglect or default Other deductions Advance paid, if any Date Amount Total 19 20 21 22 23 24 25 26 27