Labour and Employment FORM B [See Section 4(i) Proviso (b) (i)] Register of Wages Required to be maintained by Small Establishments TO BE MAINTAINED WITH IN SEVEN DAYS OF THE EXPIRY OF THE WAGE PERIOD Name of Establishment ___________________________ Name and Address of the Employer ________________________________________________ Address (Local) ________________________________________________ (Permanent) _______________ Wages Period ________________________ SL. No. Name of the employee Sex Designation Classification, whether permanent / temporary / casual part time or any other Father's or husband's name Total days number of units worked 1. 2. 3. 4. 5. 6. 7. Wages Earned Deductions Basic Wages Dearness Allowance Over Time Bonus or Maternity Benefits Gratuity Any other allowance Total Amount Statutory Actual Minimum Excreta Rate 8. 9. 10. 11. 12. 13. 14. 15. 16. Provident Fund Employees' State Insurance Advances Fines due to damage or loss by neglect or default Employer's Contribution Employees' Contribution Employer's Contribution Employees' Contribution 17. 18. 19. 20. 21. 22. Deductions Other Deductions indicating the nature Total Deductions Net Amount Payable Signature of thumb impression of employee with date Signature of Inspector with date Remarks 23. 24. 25. 26. 27. 28. Notes: 1. In case of deduction of any advance taken by an employee, the employer shall also indicate therein the number of installments paid / total installments by which advance is to be repaid such as "5/20, 6/20" etc. The purpose of advance shall also be mentioned in the Remarks column. 2. In case of imposition of fines or deduction for damage of loss, the specific act or omission for which the penalty has been imposed has to be indicated in the Remarks Column. A certificate shall also be recorded in the said column to the effect that an opportunity to show cause was given to the employee concerned before imposition of fine or deduction. Date .... Place .... Signature of the Employer with full name in Capitals
