The Uttar Pradesh Occupational Safety, Health and Working Conditions Rules, 2026
Form 15
Official text
Open in the official PDF (p. 491)
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{See Rule 57}
Leave with wages register
NAME OF ESTABLISHMENT ......................
Serial No:-..........................................................
Name:-...............................................................
Father's name:-...................................................
Department:-.....................................................
Serial no. or code in the Register of
Date and amount of payment made
employee.:-...............................................
in lieu of leave due:-..............................
Date of entry into service:-……….................
1 Calendar year service
2 Wage paid from...........……to.......................
3 Wages earned during the wage period
4 No. of days of work performed
5 No. of days of lay-off
No. of days worked
6 No. of days of maternity leave
during the calendar year
7 No. of days of leave enjoyed
8 Total of Columns 4 to 7
9 Balance of leave from preceding year
Leave to credit
1 Leave earned during the year mentioned in
0 Column 1
1
Total of Columns 9 and 10
1
1 Whether leave in accordance with scheme under
2 Section 32 was refused
1
Leave enjoyed from..................to.........................
3
1
Balance of leave to credit
4
1
Normal rate of wages
5
1
Remarks
8
Date: Signature of employer or person authorized
by him