Form 23

(see rule 75(6))

(Half Yearly Return (January to June / July to December) to be submitted by Contractor to be filed

electronically to the concerned licensing authority under rule 75(6))

1. Name and address of the contractor:

2. Name and address of the principal employer and LIN:

3. LIN of the contractor:

4. License number of the contractor (if applicable):

5. Name of the contract work with location/station:

5. Details of the number of Contract Workers, Wages Paid etc.:

Sl. Months Number Total Overtim Bonu Date and ECR ECR Wages remar

No of amoun e s amount numbe numbe paid by k

. Contract t of of Wage r of r 7th of the

Labour wages bill ESIC month or

of EPF

employe paid in received due date

d a by as

month contracto applicabl

r from e

Principal

Yes/No

Employer

January

Februar

y

March

April

May

June

Signature of the contractor:

Date:

Place: