Department of Labour and Employment FORM 15 (Prescribed under rules 97 and 98) Register of Leave with Wages Name of Factory____________________ Adult/Child _______________________ Serial No. ____________________ Name _______________________ Department ____________________ Father's Name ____________________ Serial No. in the Register of Adult child workers ____________ ____ Date of discharge __________________ Date of entry into service Date and amount of payment made Made in lieu of leave due 1. Calendar year of service 2. Wage Period -- From __________To 3. Wage earned during the wage period No of days worked during the calendar Year 4. No of days work performed - 5. No of days of lay off - 6. No of days of maternity leave - 7. No of days of leave enjoyed - 8. Total of columns (4) - (7) leave to credit - 9. Balance of leave during the year mentioned in column (1)] - 10. Leave earned during the year mentioned in column (1) 11. Total of columns (9) and (10) - 12. Whether leave in accordance with -scheme under section 79 (8) was refused 13. Leave enjoyed from to - 14. Balance of leave to credit 15. Normal Rate of wages - 16. Cash equivalent of advantages accruing -through concessional scale of food grains and other articles 17. Rate of wages for the leave period -(Total of columns (15) and (16) 18. Remarks -
