Form I

[Seerule-17andrule-41(1), (2) and (3)]

Register of Wages, Overtime, Fine, Deduction for Damage and Loss

Name of the Establishment:

Name of the Employer:

Name of the Owner:

PAN/TAN of the Employer:

Labour Identification Number (LIN):

Designatio Rates of wages

Sr. No. in Name Duration of Wag Total Total

n/

Employee of the Payment of e no. of overtime

Departme

Basic DA Allowanc

Register employ nt Wages Perio days (hours

es

ee (Monthly/Fortni d worke worked or

ghtly From d production

- To durin in case of

/Weekly/Daily/Pi

g the piecework

ece rated)

period ers)

1 2 3 4 5 6 7 8 9 10

Attendance

Overti Nature facts Amount Damage or Amount Total Date of

me and of fine loss of amount Payment

Date Signature

earning omissions imposed caused to deduction of wages

for which the from paid

fine employer wages

imposed by neglect

with date or default

of the

employee

11 12 13 14 15 16 17 18 19