Statutory Register 878

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.
Total Previous Reading Months Total Reading
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

SANITATION
SECURITY
ENGG. DEPTT.
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

Statutory Register 878

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Statutory Register 878

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ELIGIBILITY REGISTER

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

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

Sl. Emp. No. Code No.

Name of the Employee/ Arrear Father's Name Month

HR - 032 FAIR PRICE SHOP COUPON ISSUE REGISTER

Coupon No. From To

ELECTRICITY CHARGES REGISTER

Shri. ________________________________ _________________________________ _________________________________ _______________________________

Total Previous Reading Months Total Reading

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

Previous Months Total Reading

Current Months Net Reading

Charges @ 15 P. per Unit Rs. P.

Charges @ 15 P. per Unit Rs. P.

Previous Months Total Reading

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.

Department Period of Occupation From To

PAY SHEET REGISTER For the month of 200

Fair Price Shop Rs. P.

Salary Paid befire Rs. P.

Net Amount Payable after rouding off Rs. P.

Linked Insurance Scheme Rs. P.

Signature & Remarks

Daily Attendance Report for the month of 200 OFFICER

CANTEEN, GUEST HOUSE, FAIR PRICE SHOP

(Section 112, Rule 122)

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

LEAVE WITH WAGES REGISTER

Calender year of service

Wages paid Wages From To earned during the wage period

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

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

Nature of leave Casual Previlege 5 6

Unavailed leave(balance) during the season 14

NAME OF ADULT WORKER FATHER'S NAME

CORRESPONDING TO THAT IN FORM II GROUP OR RELAY SHIFT

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

TIME OF COMMENCEMENT OF WORK MONDAY TO FRIDAY SATURDAY SUNDAY

REST PERIOD TO FROM

TOTAL NO. OF DAYS WORKED

LEAVE WITH PAY

LEAVE WITHOUT PAY

TOTAL DAYS TO PAY

ATTENDANCE REGISTER for the month of

Sl. Name of No. S/Shri

Father's Name S/Shri

Leave with pay

Leave without without pay

Total Days to pay

ATTENDANCE REGISTER for the month of

Sl. Name of No. S/Shri

Father's Name S/Shri

Rate of Basic Wages

Rate of consolidated wages Rs. P.

Amount of wages earned

Loan against P.F.

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

Canteen D.C.M. Ins.

Shri. ________________ _ _ _______________