THE PUNJAB EMPLOYEE SOCIAL SECURITY INSTITUTION

DECLARATION OF EMPLOYER OF ESTABLISHMENT

(To be submitted by the employer up to 30th of each month)
1. Name of industrial/Commercial
Establishment.
2. Full Address of Establishment
Telephone No. (Plot / Property No.)
3.
4.
5.
6.

Date of start of Business.

Name of Employer.
Nature of Business.
Total No. of Employees engaged.
I.
Permanent Employees.
II.
Temporary/ Daily wages, piece
Rated employees.
III.
Contractual employees engaged
Directly or indirectly
IV. Other employees engaged in or
In connection with the affairs of
Establishment.
7. Amount of wages paid to employees
(Last month)
8. Amount of contribution paid

Month
Year

9. Number of employees in respect of

Whom contribution has been paid.
Date:
Name & Signature of Employer
Or his Agent with seal/ stamp