Form XXI

Made under The Occupational Safety, Health and Working Conditions Code, 2020Notification No. 101, 30 Jun 2026

Official text

Open in the official PDF (p. 399)

Tables and forms lose their layout when extracted; the PDF is the authoritative version.

(See Rule-63)

Home Workers Log Book

1. Name and address of the Beedi Company

2. Name and address of the local employer/ Manager of the Company

3. Name and address of the Contractor/ Commission Agent

4. Central Excise Licence Number (L-2)

5. Name and address of the Beedi Worker

6. Address of the house where Beedis are manufactured

Account of work done at home and wages paid therefor

Date month Weight of tobacco and No. of Beedis No. of rejected Wages payable

and year leaves received manufactured Beedis for

manufactured

Tobacco Leaves

Beedis

1 2 3 4 5 6

Wages payable Adjustment of Net Signature or left Signature of Remarks

for rejected advance or amount of thumb- Employer/

Beedis deduction, if wages impression of Commission

any actually Home worker Agent

paid and

received

7 8 9 10 11 12

Source: The Occupational Safety, Health and Working Conditions (Bihar) Rules, 2026, Notification No. 101 — Bihar Gazette Extraordinary No. 699, 1 July 2026, p. 399 of the PDF. Open our copy at p. 399 · official download · all sources