The Code on Wages (Lakshadweep) Rules, 2025
Form IV
Official text
Open in the official PDF (p. 22)
Tables and forms lose their layout when extracted; the PDF is the authoritative version.
[See rule 41(3)]
EMPLOYEE REGISTER
Name of the Establishment:
Name of the Employer:
Name of the Owner:
PAN/TANof the Employer:
Labour Identification Number (LIN):
Sl. Nam Surnam Gende Father Nationa
Empl Dat Educa Date Desig Categor Type
No e e r ’s lity
. oyee / eof tion of natio y(HS/S/ of
Code Birt Level Joini n SS/US)* Emplo
Spous
h ng yment
e
Name
1 2 3 4 5 6 7 8 9 10 11 12 13
UAN PAN AADHAA Bank
Mobile ESI Bank Branc Present Permane
R
C A/c h Addres
No. nt
IP Numbe (IFSC s
r ) Address
No.
14 15 16 17 18 19 20 21 22 23
Service Date Reason Mark of Photo Specimen Remarks
Book of for Exit Identification Signature/Thum
No. Exit b Impression
24 25 26 27 28 29 30
*(Highly Skilled/ Skilled/ Semiskilled/ Unskilled)