FORM IV ANNUAL RETURN UNDER THE PAYMENT OF WAGES ACT, 1936 Wages and deduction from wages return for the year ending 31st December, 20_____. 1. (a) Name of the factory or establishment and postal address____________ (b) Code no. _____________________ (c) Industry_____________________ 2. Number of days worked during the year. 3. (a) Number of man-days worked during the year (Total Attendances)-Adults ____________________________ Children__________________________ (b) Average daily no. of persons employed during the year Adults ____________________________ Children___________________________ (c) Gross amount paid as remuneration including deductions under Section 7 (2)______________ of which the amount due to profit sharing bonus is ______________________ money value of concession ** is 4. Total wages paid including deduction under Section 7 (2) on the following account (a) Basic wages including over time wages and non- profit sharing bonus_____________________________ (b) Dearness and other Allowances in cash__________________________ (c) Arrears of pay in respect of previous year paid during the year__________________ 5. Total unclaimed amount including wages, bonus, fines/Deductions etc._________________________ Page 24 of 151 6. Number of cases and amount realized as: No. of cases Amount Rs. Rs. (a) Fines (b) Deductions for damages or loss (c) Deduction for breach of contract Reimbursement from the fines fund- Purposes(a)______________________ (b)______________________ (c)______________________ (d)______________________ 11. Balance of fine fund in hand at the end of the year______________________ Signature _____________________ Designation____________________ *This is the aggregate number of attendances during the year. **This average daily number of persons employed during the year is obtained by dividing the aggregate number of attendances during the year by the number of working days. ***Money value of concessions should be obtained by taking difference of the cost price paid by the employer and the actual price paid by the employees for supplies of essential commodities given free or at concessional rates. Page 25 of 151
