FORM NO. FORM I FORM II FORM III FORM IV FORM V FORM VI FORM VII FORM VIII FORM I.

FORM . FORM .I FORM .II FORM .III FORM .IV FORM .V FORM .VI FORM .VII FORM .VIII FORM .I. FORM .. FORM ..I FORM ..II FORM ..III FORM ..IV FORM ..V Certificate of Registration Register of Registration Application of License Application for adjustment of

FORM DESCRIPTION Application for Registration of Establishment Employing Contract Labour

ecurity !eposit

RE"E#AL$ %VI&A ' () "otice of Commencement*completion of Contract #or+ Application for Rene,al of License Application for -emporary Registration of Establishments employing Contract Labour -emporary Certificate of Registration Application for -emporary License -emporary License Register of Contractors Register of ,or+men employed by Contractor Employment Card er/ice Certificate Muster roll Register of #ages Form of Register of #ages&cum&Muster Roll #age lip Register of !eductions for !amage of Loss Register of Fines Register of Ad/ances Register of O/ertime Return to be sent by the Contractor to the Licensing Officer Annual Return of 0rincipal Employer to be sent to the Registering Officer

FORM I [See rule 17 (1)) Application for Registration of Establishment Emplo ing !ontract "abour 1$ "ame and location of the establishment$ 2$ 0ostal address of the establishment$ 3$ Full name and address$ of the principal employer %furnish father4s name in the case of indi/iduals)$ 5$ Full name and address of the manager or person responsible for the super/ision and control of the establishment$ 6$ "ature of ,or+ carried on in the establishment$ 7$ 0articulars of contractors and contract labour 8 %a) "ames and addresses of contractors$ %b) "ature of ,or+ In ,hich contract labour is employed or is to be employed$ %c) Ma9imum number of contract labour to be employed on any day through each contractor $ I:%cc) Estimated date of commencement of each contract ,or+ under each contractor$) %d) Estimated date of termination of employment of contract labour under each contracto;$ 2:<$ 0articular of demand draft enclosed&%"ame of the =nion (an+> amount> demand draft "o$ and date)?$ I hereby declare that the particulars gi/en abo/e are true to the best of my @no,ledge and belief$

0rincipal employer eal and stamp Office of the Registering Officer

!ate of receipt of application$

FORM II [See rule 1# (1)) !ertificate of Registration

"o$ &&&&&&&&&&&&&

!ate &&&&&&&&&&&&&&&&&

$o%ernment of In&ia' Office of the Registering Officer A certificate of registration containing the follo,ing particulars is hereby granted under sub&section %2) of ec$ < of the Contract Labour %Regulation and Abolition) Act>

1A<B and the rules made there under to 1$ "ature of ,or+ carried on in the establishment$ 2$ "ames and addresses of contractors$ 3$ "ature of ,or+ in ,hich contract labour is employed or is to be employed$ 5$ Ma9imum number of contract labour to be employed on any day through each contractor $ 6$ Other particulars rele/ant to the employtnent of contract labour $

ignature of Registering Officer ,ith 1( Ins( b $(S(R( 1))' &ate& *+1h ,anuar ' 1)77 (-(e(l( 1*1h Februar ' 1)77)( *(Subs( b $(S(R( .+7' &ate& Illh August' 1)#7 (-(e(l( **n& August' 1)#7)( eal$

FORM Ill (See rule 18 (3)] Register of Registration

Si. Registration Name and address of Name of the T !e of "usiness# No. No. and date the esta"lishment !rin$i!al trade# Industr # registered em!lo ment manufa$ture or and his o$$u!ation# address %hi$h is $arried on in the esta"lishment 1( 3 ) * +arti$ulars of $ontra$tor and $ontra$t la"our Name and Nature of %or& Ma,imum No. of +ro"a"le duration address of in %hi$h $ontra$t la"our of em!lo ment of $ontra$tor $ontra$t la"our to "e em!lo ed- $ontra$t la"our is em!lo ed or on an da is to "e em!lo ed . 8 / 10

Total No. of %or& men dire$tl em!lo ed

'

Remar&s

11

FORM I/ (See rule *1 (1)) Application of "icense

1$ "ame and address of the contractor %including his father4s name in case of indi/iduals)$ 2$ !ate of birth and age %in case of indi/iduals)$ 3$ 0articulars of establishment ,here contract labour is to be employed 8 %a) "ame and address of the establishment$ %b) -ype of business> trade> industry> manufacture or occupation ,hich is carried on in the establishment$ %c) "umber and date of certificate of registration$ of the establishment under the Act$ %d) "ame and address of the principal employer$

5$ 0articulars of contract labour 8 %a) "ature of ,or+ in ,hich contract labour is employed or is to be employed in the establishment$ %b) !uration of the proposed contract ,or+ %gi/e particulars of proposed date of commencing and ending)$ %c) "ame and address of the agent or manager or contractor at the ,or+ site$ %d) Ma9imum number of contract labour proposed to be employed in the establishment on any date$

6$ #hether the contractor ,as con/icted of any offence ,ithin the preceding

fi/e years$ If so> gi/e details$

7$ #hether there ,as any order against the contractor re/o+ing or suspending licence or forfeiting security deposits in respect of an earlier contract$ If so> the date of such order $

<$ #hether the contractor has ,or+ed in any other establishment ,ithin the past fi/e years$ If so> gi/e details of the principal employer> establishment and nature of ,or+$

C$ #hether a certificate by the principal employer in Form V is enclosed$

1

:A$ Amount of licence&fee&"ame of the =nion (an+> !emand !raft "o$ and

date$

1B$ Amount of security deposit&"ame and =nion (an+> !emand !raft "o$ and date$? D-he amount of security or balance> if any> after adjustment of amount to be refunded under rule 3B> if any> deposited ,ith treasury receipt number and date$D !eclaration$&1 hereby declare that the details gi/en abo/e are correct to the best of my +no,ledge and belief$E 0lace 8 !ate 8

ignature of the applicant %Contractor)$

:"ote$&-he application shall be accompanied by demand draft and the challan

for the appropriate amount and a certificate in Form V from the principal employer date of the receipt of the application ,ith Ddemand draftD and the challan for fees*security deposit$? %f o be filled in the office of the Licensing Officer) !ate of receipt of the application ,ith challan for fee of security deposit$ ignature of the Licensing Officer $

1(Subs( b $(S(R( .+7' &ate& Ilth August' 1)#7 (-(e(f( **n& August' 1)#7

FORM / [See rule *1 (*)0 Form of !ertificate b 1rincipal Emplo er Certified that I ha/e engaged the applicant %name of the contractor) as a contractor I my establishment$ I underta+e to be bound by all the pro/isions of the Contract Labour %Regulation and Abolition) Act 1A<B> and the Contract Labour %Regulation and Abolition) Central Rules> 1A<1> in so far as the pro/isions are applicable to me in respect of the employment of contract labour by the applicant in any establishment$

0lace 8 Employer !ate8 establishment

ignature of 0rincipal

"ame and address of

A22E34RE -he licence Is subject to the follo,ing conditions 1$ -he licence shall be non&transferable$ 2$ -he number of ,or+men employed as contract labour in the establishment shall not&on any day> e9ceed 3$E9cept as pro/ided in the rules the fees paid for the grant or> as the case may be> for rene,al of the licence shall be non&refundable$ 5$ -he rates of ,ages payable to the ,or+men by the contractor shall not be less than the rates prescribed for the schedule of employment under the Minimum #ages Act> 1A5C> ,here applicable> and ,here the rates ha/e been fi9ed by agreement> settlement or a,ard> not less than the rates fi9ed$ 6$ In cases ,here the ,or+men employed by the contractor perform the same or similar +ind of ,or+ as the ,or+men directly employed by the principal employer of the establishment> the ,age rates> holidays> hours of ,or+ and other conditions of ser/ice of the ,or+men of the contractor shall be the same as applicable to the ,or+men directly employed by the principal employer of the establishment on the same or similar +ind of ,or+> pro/ided that in the case of any disagreement ,ith regard to the type of ,or+ the same shall be decided by the Chief Labour Commissioner %Central) ,hose decision shall be final$

7$ In other cases the ,age rate$> holidays> hours of ,or+ and conditions of ser/ice of the ,or+men of the contractor shall be such as may be specified In this behalf by the Chief Labour Commissioner %Central)$ <$ In e/ery establishment ,here 2B or more ,omen are ordinarily employed as contract labour there shall be pro/ided t,o rooms of reasonable dimensions for the use of their children under the age of sI9 years$ One of such rooms ,ould be used as a play room for the children and the other as bed room for the children$ For this purpose the contractor shall supply adeFuate number of toys and games In the p lay room and sufficient number of cots and beddings In the sleepIng room$ -he standard of construction and maintenance of the creche$ may be such as may be specified In this behalf by the Chief Labour Commissioner %Central)$ C$ -he licence shall notify any change In the number of ,or+men or the conditions of ,or+ to the =censing Officer$ A copy of the licence shall be displayed prominently at the premises ,here the contract ,or+?$ being carried on$)
1[)(

211B$ -he licensee shall> ,ithin fifteen days of the commencement and completion of each contract ,or+ submit a return to the Inspector appointed under ec$ 2C of the Act Intimating the

actual date of the commencement or> as the case may be> completion of such contract ,or+ In Form VI&A$G 1(Ins( b $(S(R( )5#' &ate& 1*th ,ul ' 1)7#
6[FORM /I7A

(See rule *+ (*) (viii) Notice of commencement / completion of Contract Work I*#e> hri*Messrs$ %name and address of the contractor) hereby intimate that the contract ,or+ %name of ,or+) In the establishment of %name and address of principal employer) for ,hich Licence "o&&&&&&&&& > dated&&&&&&&&& has been issued to me*us by the Licensing Officer %name of the headFuarter)> has been commencedH completed ,ith effect from %date)*on %date)$

ignature of the Contractor %s)$ -o -he inspector> &&&&&&&&&&&&&& &&&&&&&&&&&&&&

6[FORM /I78

(See rule #1(6)1 2otice of Commencement/completion of Contract Work 1$ "ame of the principal employer and address 2$ "umber and date of Certificate of Registration 3$ I*#e hereby intimate that the contract ,or+ %name of ,or+) gi/en to %name and address of the contractor) ha/ing Licences "o &&&&&&&& dated&&&&&&&&has been commenced*completed ,ith effect from %date)*on %date)$

ignature of the principal employer$

FORM /II

[See rule *) (*)1 Application for Rene-al of "icence I$ "ame and address of the contractor&&&&&&&&&&&&&&&&&&&&&&&&& 2$ "umber and date of the licence &&&&&&&&&&&&&&&&&&&&&&&&&&&& 3$ !ate of e9piry of the pre/ious licence &&&&&&&&&&&&&&&&&&&&&& 5$ #hether the licence 4of the contractor ,as suspended or re/o+ed &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 6 "ame of the (an+> number and date of the demand draft enclosed$ !ate of receipt of the application ,ith demand draft number and date$)

0lace&&&&&&&&&& !ate&&&&&&&&&&&

ignature of 4the Applicant$

%-o be filled In office of the Licensing Officer) !ate of receipt of the application ,ith -reasury Receipt number and date$

ignature of the Licensing Officer$

FORM /II

[See rule *) (*)1 Application for Rene-al of "icence I$ "ame and address of the contractor&&&&&&&&&&&&&&&&&&&&&&&&& 2$ "umber and date of the licence &&&&&&&&&&&&&&&&&&&&&&&&&&&& 3$ !ate of e9piry of the pre/ious licence &&&&&&&&&&&&&&&&&&&&&& 5$ #hether the licence 4of the contractor ,as suspended or re/o+ed &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 6 "ame of the (an+> number and date of the demand draft enclosed$ !ate of receipt of the application ,ith demand draft number and date$)

0lace&&&&&&&&&& !ate&&&&&&&&&&&

ignature of 4the Applicant$

%-o be filled In office of the Licensing Officer) !ate of receipt of the application ,ith -reasury Receipt number and date$

ignature of the Licensing Officer$

FORM I3 [See rule 6* (6)0 1[ 9emporar !ertificate of Registration0

"o&&&&&&&&&&&&&

!ate&&&&&&&&&&&&&&&&

!ate of e9piry&&&&&&&&&&&&&&

$o%ernment of In&ia Office of the Registering Officer A -emporary Certificate of Registration*containing the follo,ing particulars is hereby granted under sub&section %2) of ec$ < of the Contract Labour %Regulation and Abolition) Act> 1A<B and the rules framed there under> toI /alid from to 1$ "ame of ,or+ carried on in the establishment 2$ "ature of ,or+ in ,hich contract labour is to be employed 3$ Ma9imum number of contract labour to be employed on any day 5$ Other particulars rele/ant to the employment of contract labour ignature of Registering Officer ,ith eal$

FORM 3 [See rule 6* (*)0 Application for 9emporar "icense 1$ "ame and address of the contractor %including his father4s name in case of indi/iduals) 2$ !ate of birth and age %in case of indi/iduals)$ 3$ 0articulars of establishment ,here> contract labour is to be employed

%a) "ame and address of the establishment$

%b) -ype of business> trade> industry> manufacture or occupation ,hich is carried on in the establishment$

%c) 4"ame and address of the principal employer$

5$ 0articulars of contract labour8

%a) "ature of ,or+ in ,hich contract labour is to be employed in the establishment$

%b) !uration of the proposed contract ,or+ %gi/e particulars of proposed date of commencing and ending)$

%c) "ame and address of the agent or manager of contractor at the ,or+& site$

%d) Ma9imum number of contract labour proposed to be employed in the establishment on any date$

6$ #hether the contractor ,as con/icted of any offence ,ithin the preceding fi/e yearsJ if so> gi/e details$

7$ #hether there ,as any order against the contractor re/o+ing or suspending licence or forfeiting security deposits in respect of an earlier contract J If so the date of such order

<$ #hether the contractor has ,or+ed in any other establishment ,ithin the past fi/e years J If so> gi/e details of the principal employer> establishment and nature of ,or+$

2%C$ Amount of licence fee paidIname of the =nion (an+> !emand !raft "o$ and date

2:A Amount of security depositIname of the =nion (an+> !emand !raft "o$ and date> !ate of the receipt of the application ,ith demand draft for fee*security deposits$? I hereby declare that the particulars gi/en abo/e are true to the best of my +no,ledge and belief$

111111111111111111111111
ignature of the applicant %Contractor)$ 0lace&&&&&&&&&&&&&& !ate&&&&&&&&&&&&&&

%-o be filled in the office of the Licensing Officer) !ate of receipt of the application ,ith challan for fees*security deposit$

ignature of the Licensing Officer 1(Subs' for the -or&s :Office of the "icensing Officer:' %i&e $(S(R( 1.5)' &ate& 1.th ;ecember' 1)7*( *( Subs( b $(S(R( .+7' &ate& 11th August' 1)#7 (-(e(f( **n& August' 1)#7)(

FORM 3I [See rule 6* (6)0 $o%ernment of In&ia Office of the "icensing Officer Licence "o &&&&&&&& !ate&&&&&&&&&&&&&&&& Fee paid Rs&&&&&&&&&&&&&& ignature of the Licensing Officer E9pires

on&&&&&&&&&&&&&&&&&&&&& -emporary Licence

License is hereby granted to &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& under ec$12 %2) of the Contract Labour %Regulation and Abolition) Act> 1A<B> subject to the conditions specified in Anne9ure$ -he licence shall remain in force till$

ignature and !ate&&&&&&&&&&&&&&&&&& A22E34RE -he licence is subject to the follo,ing conditions 1$ -he licence shall be non&transferable$

eal of the Licensing Officer$

2$ -he number of ,or+men employed as contract labour in the establishment shall not> on any day> e9ceed 3$ E9cept as pro/ided in the rules the fees paid for the grant of the licence shall be non& refundable$ 5$ -he rateK of ,ages payable to the ,or+men by the contractor shall not be less than the rates prescribed for the schedule of employment under the Minimum #ages Act> 1A5C> ,here applicable> and ,here the rates ha/e been fi9ed by agreement> settlement or a,ard> not less than the rates fi9ed$ 6$ In cases ,here the ,or+men employed by the contractor perform the same or similar +ind of ,or+ as the ,or+men directly employed by the principal employer of the establishment> the ,age rates> holidays> hours of ,or+ and other conditions of ser/ice of the ,or+men of the contractor shall be the same as applicable to the ,or+men directly employed by the principal employer of the establishment on the same or similar +ind of ,or+ pro/ided that in the case of

any disagreement ,ith regard to the type of ,or+ the same shall be decided by the Chief Labour Commissioner %Central) ,hose decision shall be final$ 7$ In other cases the ,age rates> hoidays>hours of ,or+ and conditions of ser/ice of the ,or+men of the contractor shall be such as may be specified in this behalf by the Chief Labour Commissioner %Central) 1:<$ A copy of the license shall be displayed prominently at the premises ,here the contract ,or+ is being carried on$? *( Subs b $(S(R( .+7' &ate& 11th August( 1)#7 (-(e(f( **n& August' 1)#7)(

FORM 3II % ec rule <5) Register of Contractors %1) "ame and address of the principal employer&&&&&&&&&&&&&&&&&&&&&& %2) "ame and address of the establishment &&&&&&&&&&&&&&&&&&&&&&

r$ "o$ 1

"ame and Location of "ature of ,or+ address of contract on contract contractor ,or+ 2 3 5

0eriod From 6 -o 7

of contract Ma9imum number of ,or+men employed by contractor <

FORM 3III (See rule 7+) Register of -or<men emplo e& b !ontractor "ame and address of contractor "ame and address of establishment In*under ,hich contract Is carried on "ature and location of ,or+ "ame and address of principal employer

r$ "ame and Ag$ and "o$ surname se9 of ,or+man

Father4s*Lusband4s "ature of name employment*designation

0ermanent home address of ,or+man %/illage and -ehsil*talu+a and district)

Local address

!ate of commence& ment of employment

ignature Or thumb Im& pression of ,or+men A

!ate of termination of4 employ ment

Reasons for termination

Remar+s

<

1B

11

12

1( ins b $(S(R( )5#( &ate& 1*th ,ul ' 1)7#

FORM 3I/ (See rule 7.) Emplo ment !ar&

"ame and address of contractor "ame and address of establishment in*under ,hich contract is carried on "ature of ,or+ and location of ,or+ "ame and address of principal employer

1$ "ame of the ,or+man

2$

erial number in the register of ,or+men employed

3$ "ature of employment*designation

5$ #age4 rate ,ith particulars or unit> in case of piece ,or+

6 #age period

7$ -enure of employment

<$ Remar+s

ignature of Contractor$

FORM 3/ (See rule 77) Ser%ice !ertificate

"ame and address of contractor &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and address of> establishment in*under ,hich contract is carried on &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ature and location of ,or+&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and address of principal employer&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and address of the ,or+man&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Age or date of birth&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Identification mar+s&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Father4s*Lusband4s name$&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

r$ -otal period for ,hich employed "o$ From -o

"ature of ,or+ Rate of ,age done %,ith particulars of unit in case of piece ,or+) 5 6

Remar+s

ignature&&&&&&&&&&&&&&&&

FORM 3/I 1[See rule 7# (1) (a) (i)0 Muster roll "ame and address of contractor &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and address of establishment in*under ,hich contract is carried on&&&&&&&&&&&&&&&&&&&& &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ature and location of ,or+ &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and address of principal employer &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& For the month of &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

r$ "o$ 1

"ame of ,or+man "o$

Father4s*Lusband4s name

e9

!ates 12356

Remar+s

7 6

FORM 3/II
1[See

rule 7# (1) (a) (i)0

Register of =ages "ame and address of contractor &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

"ame and address of establishment In*under ,hich contract is carried on &&&&&&&&&&&&&&&&&&&&&&

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ature and location of ,or+ &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

"ame and address of principal employer&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& #age period Monthly &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 1( Subs( b $(S(R( )5#' &ate& 1*th ,ul ' 1)7#

r "o$

"ame of ,or+man

erial "o$ in the !esignation* register of ,or+men nature of ,or+ done 3 5

"o$ of days ,or+ed

=nits of ,or+ done

!aily rate of ,ages*piece rate

<

Amount of ,ages earned

(asic ,ages

!earness O/er&time Other -otal allo,ance cash payments %nature of payment to be indicated)

!eduction "et ignature* Initials of con If any amount thumb& tractor the %Indicate paid Impression representati/e nature) of ,or+man

1B

11

12

13

15

16

17

FORM 3/III

1ISee

rule 7# (1) (a) (I)0

Form of Register of =ages7cum7Muster Roll "ame and address of contractor "ame and address of establishment in*under ,hich contract is carried on "ame and address of principal employer #age period #ee+ly*Fortnightly From to "ature and location of ,or+

L$"o$in "ame of !esignation* !aily -otal !aily rate of attendance*units attendance*units ,ages*piece l register employee nature of ,or+ of ,or+ done rate "o$ of ,or+men ,or+ed 1 2 3 5 6 7 <

Amount of ,ages earned (asic ,ages !earness O/er& Other cash

-otal !eduction> "et if any amount %indicate paid nature) thumb&

ignature* Initials

allo,ance time payments

of con& tractor or the representati/e

%nature of payment to be indicated) C A 1B 11 12

impres& sion of ,or+man

13

15

16

17

1( Subs( b $(S(R( )5#' &ate& 1*th ,ul ' 1)7#

FORM 3I3 1[See rule 7# (1) (b)0 =age Slip "ame and address of contractor &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and father4s*husband4s name of the ,or+man&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ature and location of ,or+ &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& For the ,ee+*fortnight*month ending &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 1$ "umber of days ,or+ed &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 2$ "umber of units ,or+ed in case of piece rate ,or+ers &&&&&&&&&&&&&&&&&&&&&&&& 3$ Rate of daily ,ages*piece rate &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 5$ Amount of o/ertime ,ages &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 6$ Mross ,ages payable a &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& 7$ !eductions> If any &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& <$ "et amount of ,ages paid &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& Initials of the Contractor or his representati/e$ &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

FORM 33 1[See rule 7# (1) (a) (ii)0 Register of ;e&uctions for ;amage or "ou "ame and address of contractor &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& "ame and address of establishment in*under ,hich contract Is carried on &&&&&&&&&&&&&&&&&&&&&&&& "ature and location of ,or+ "ame and address of principal employer&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

r$ "o$

"ame of

Father4s* Lusband4s name 3

!esignation* "ature of employment 5

0articulars of damage or loss 6

!ate of damage or loss 7

#hether ,or+ man sho,ed cause against deduction

,or+man 1 2

<

Name of !erson In %hose !resen$e em!lo ee-s e,!la nation %as heard 8

2mount of dedu$tion im!osed

No. of installments

3ate of re$o4er First installment 5ast installment 1( Remar&s 13

10

11

FORM XXI 1[See rule 78 (1) a) (ii)] Register ! Fi"es Name and address of $ontra$tor 1111111111111111111111111111111111111111111111111111111111111 Name and address of esta"lishment in6under %hi$h $ontra$t is $arried on11111111111111111111111 Nature and lo$ation of %or& Name and address of !rin$i!al em!lo er 111111111111111111111111111

Sr. No.

Name of %or&man

Father-s7 8us"and-s name

3esignation Nature 2$t6Omission for of em!lo ment %hi$h fine im!osed

3ate of offen$e

9hether %or&man Name of sho%ed $ause against !erson in fine %hose !resen$e em!lo ee-s e,!lanation %as heard . 8

'

9age !eriods and %ages !a a"le /

2mount of fine Im!osed 10

3ate on %hi$h fine reali:ed 11

Remar&s 1(

1( Subs( b $(S(R( )5#' &ate& 1*th ,ul ' 1)7#(

FORM XXII
1(See

rule 78 (1) (a) (ii)]

Register ! #$%a"&es Name and address of $ontra$tor 11111111111111111111111111111111111111111111111111111111111111111111 Name and address of esta"lishment in6under %hi$h $ontra$t is $arried on 111111111111111111111111111111 Nature and lo$ation of %or&11111111111111111111111111111111111111111111111111111111111111111111111111 Name and address of !rin$i!al em!lo er 11111111111111111111111111111111111111111111111111111111111111

Sr. No.

Name

Father-s6

Nature of em!lo ment6 designation

9age !eriod and %ages !a a"le

3ate and amount of ad4an$e gi4en

+ur!ose (s) for %hi$h ad4an$e made .

8us"ands name 1 ( 3

'

No. of installments " %hi$h ad4an$e to "e re!aid 8

3ate and amount of ea$h installment re!aid /

3ate on %hi$h last installment Remar&s %as re!aid 10 11

FORM XXIII
1[See

rule 78 (1) (a) (iii)]

Register ! O%erti'e Name and address of $ontra$tor 11111111111111111111111111111111111111111111111111111111111111111 Name and address of esta"lishment in6under %hi$h $ontra$t is $arried on111111111111111111111111111 Nature and lo$ation of %or&1111111111111111111111111111111111111111111111111111111111111111111111 Name and address of !rin$i!al em!lo er11111111111111111111111111111111111111111111111111111111111

Sr No. 1

Name of %or&man

Father-s68us"and-s Se, name 3 -)

3esignation6 Nature of em!lo ment *

3ate on %hi$h o4ertime Total o4ertime %or&ed or %or&ed !rodu$tion in $ase of !ie$e1rated ' .

Normal rate of %ages 8

O4ertime rate of %ages O4ertime earnings / 10

3ate on %hi$h o4ertime %age !aid 11

Remar&s 1(

1. Su"s. " ;.S.R. /)8# dated 1(th <ul # 1/.8

FORM XXI( [See rule 8) (1)] Retur" t *e se"t *+ t,e C "tra&t r t t,e -i&e"si"g O!!i&er 8alf1 ear ending1111111111111

1. Name and address of the $ontra$tor11111111111111111111111111111111111111111111111111111111 (. Name and address of the esta"lishment 1111111111111111111111111111111111111111111111111111 3. Name and address of the !rin$i!al em!lo er 111111111111111111111111111111111111111111111111 ). 3uration of $ontra$t From to 11111111111111111111111111111111111111111111111111111111111111 *. Num"er of da s during the half1 ear on %hi$h 1111111111111111111111111111111111111111111111 (a) the esta"lishment of the !rin$i!al em!lo er had %or&ed 111111111111111111111111111111111111 (") the $ontra$tor-s esta"lishment had %or&ed 111111111111111111111111111111111111111111111111 '. Ma,imum num"er of $ontra$t la"our em!lo ed on an da during the half ear 111111111111111 Men1111111 9omen 11111111 =hildren 11111111111111 Total 111111111111111111111111111 .. (I) 3ail hours of %or& and s!read1o4er (II) (a) 9hether %ee&l holida s o"ser4ed and on %hat da 111111111111111111111111111111111111111 (") If so# %hether it %as !aid for 1111111111111111111111111111111111111111111111111111111111111111

(III) Num"er of man1hours of o4ertime %or&ed 111111111111111111111111111111111111111111111111111

8. Num"er of man da s %or&ed " > Man 1111111111111 9omen 11111111111111 =hildren 111111111111111 Total 11111111111111111111111111 /. 2mount of %ages !aid> Man11111111111111111111 9omen11111111111111 =hildren 1111111111111 Total 1111111111111111111111 10. 2mount of dedu$tion from %ages# If an ? Man111111111111 9omen 1111111111111111 =hildren 1111111111111111 Total111111111111111111111111 11. 9hether the follo%ing ha4e "een !ro4ided (I) =anteen1111111111111111111111111111111111111 (II) Rest1rooms111111111111111111111111111111111 (III) 3rin&ing %ater11111111111111111111111111111 (I@) =rA$he 11111111111111111111111111111111111 (4) First1aid11111111111111111111111111111111111 (if the ans%er is - es- state "riefl standards !ro4ided) Signature of =ontra$tor.

+la$e11111111 3ate 1111111

FORM 33/ [See rule #* (*)) Annual Return of 1rincipal Emplo er to be sent to the Registering Officer >ear en&ing 61st ;ecember(

1$ Full name and address of the principal employer 2$ "ame of the establishmentI

%a) !istrict

%b) 0ostal address

%c) "ature of operation*Industry*,or+ carried on

3$ Full name of the manager or person responsible for super/ision and control of the establishment 5$ "umber of contractors ,ho ,or+ed in the establishment during the year %Mi/e details in Anne9ure) 6$ "ature of ,or+*operation on ,hich contract labour ,as employed 7$ -otal number of days during the year on ,hich contract labour ,as employed <$ -otal number of man&days ,or+ed by contract labour during the year C$ Ma9imum number of ,or+men employed directly on any day during the year A$ -otal number of days during the year on ,hich direct labour ,as employed 1B$ -otal number of man&days ,or+ed by directly employed ,or+men 11$ Change> If any> in the management of the establishment> Its location> or any other particulars furnished to the Registering Officer> In the application for registration indicating also the dates

0rincipal Employer$

0lace !ate

A22E34RE 9O FORM

"ame and address of the cont ractor

0eriod of contract From -o

"ature of ,or+

Ma9imum number of ,or+ers employed by & each contractor

"umber of days ,or+id

"umber of man&days ,or+ed

<