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PAYMENT OF WAGES ACT 1936

FORM V
(See Rule 18)

ANNUAL RETURN
Return For The Year Ending the 31st Dec., 2014
1.

(a
)

Name
of
establishment
postal address.

the
and

(b
)

Full name of Registered


Office .

(c
)

Name and residential


address of the Owner.

(d
)

Name and residential


address of incharge of
day today affairs of the
establishment owned by
a
company,
body
corporate or association.

2.

Numbers of days
during the year.

worked

**
3

(a
)

Number of man-days
worked during the year.

Persons receiving less


than Rs. 1600/- per
month

Persons receiving Rs. 1600 and


more but less than Rs. 1800/per month.

Adults

NIL

NIL

Children

NIL

NIL

NIL

NIL

(b) Average Daily No. of persons employed during the year. 71


Nos.

Persons receiving less


than Rs. 1600/- per
month

Persons receiving Rs. 1600 and


more but less than Rs. 1800/per month.

Adults

NIL

NIL

Children

NIL

NIL

NIL

NIL

4.

(c)

Gross amount aid as remuneration to person getting less


than Rs. 1600/- per month including deduction under
7(2) Nil of which the amount due to profit sharing and
that due to money value of concessions in NIL.

(d)

Gross amount paid as remuneration to person, getting


Rs. 1600 more but less than Rs. 1800/- per month
including deductions under sections 7(2) is Nil of which
that amount due to profit sharing bonus is Nil and that
due to money value concession Nil.

Total wages paid including deduction under section 7(2) on


the following account :
Person receiving
less than Rs.
1600/- per month.

(a) Basic
wages NIL
including overtime
wages and nonprofit
sharing
bonus.
(b) Dearness and other NIL
Allowance in cash.
(c) Arrears of pay in NIL
respect of previous
year paid during
the year.
5.

Persons receiving Rs.


1600 and more but
less than Rs. 1800/per month.
NIL

NIL
NIL

Number of cases and amount realized as :Persons receiving less Persons receiving Rs.
than Rs. 1600/- per
1600/- and more but

month.
No. of
Cases

less than Rs. 1800/per month.

Amount

No. of
Cases

Amount

NIL

NIL

NIL

NIL

(b Deduction
for NIL
) damage or loss.

NIL

NIL

NIL

for NIL
of

NIL

NIL

NIL

(a Fines
)

(c Deduction
) breach
contract.

(d Disbursement
) from
the
fine
fund.

Purpose

Amount

(a NIL
)

NIL

NIL

NIL

NIL

(b NIL
)

NIL

NIL

NIL

NIL

(c NIL
)

NIL

NIL

NIL

NIL

(d NIL
)

NIL

NIL

NIL

NIL

(e NIL
)

NIL

NIL

NIL

NIL

7.
Balance of
--------NA-----------

fine

fund

in

hand

at

the

end

of

year.

Date: 31.01.2011
Signature ..........................................
Designation :
Manager
This is the aggregate number of attendance during the year.

The average daily number of person employed during the yea


is obtained by dividing the aggregate attending during the year by
the number of working days.
Money value of concessions should be obtained by taking the
difference of the cost price paid by the employer and actual paid of
employees for supplies of essential commodities given free or at
confessional rates.
** Strike of whichever is not applicable.

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