Form IV

(See clause (ii) of sub rule (1) of rule 51)

REGISTER OF WAGES, OVERTIME, ADVANCES, FINES AND DEDUCTIONS

FOR DAMAGE AND LOSS

Name of the

Establishment

Name of the

Employer

Name of the Owner

PAN/TAN of the

Employer

Registration

Number of the

establishment

(Labour

Identification

Number (LIN) shall

be

the Registration

Number of the

Establishment)

Sr. No. Nam De De Duration of Wage Total no. of Total overtime Rate of

in e sig partPayment of wages Perio days hours worked or wages

Sl me

Employof nati (Monthly/ d worked overtime BD All

. nt

ee the on Fortnightly/WeeklyFrom-during the production in case asA ow

N

Registe empl / Daily/Piece rated) To wage of piece workers ic anc

o.

r/ oyee period es

Employ

ee

Code

(1) (2) (3) (4) (5) (6) (7) (8) (9) (1 (1 (12)

0) 1)

Amount of wages Deductions Net

earned Paymen

Bas DA All Ove Total EPF ESI Soc Inc Insu Adv Reco Recovery Tota Oth t

ic ow rtim wages C iety om ranc ance very on l ers

anc e earned e e s of account Ded

es Tax Fine of uctio

Damages/ ns

Losses

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28)

Date of Receipt by Nature of acts Amount Damage or loss Signature of

Payment employee/Bank and omissions of fine caused to the Employer/Employer

transaction ID for which fine imposed employer by Representative*

imposed with neglect or default

date of the employee

(28) (29) (30) (31) (32) (33)

*Note: Required in case register is maintained physically.