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Rules

Annexure

Annexure

Form 'A'

[See Rule 3(4)]

Statement of employees' and employers' contribution for the six months ending on the 30th June and the 31st December, respectively

  1. Name of the establishment
  2. Name of the employer
  3. Class of establishments (i.e. whether a factory of motor omni bus service, a shop, commercial establishment, residential hotel, restaurant, eating house, theatre or other place of public amusement or entertainment). 4. Address of the establishment
  1. Total number of employees whose names stands on the establishment register on the 30th June/the 31st December.
  2. (a) Employees' contribution at the rate of Rs. ______________

(b) Employers' contribution at the rate of Rs. ______________ per employee,

  1. Total of sub-entries (a) and (b) of entry 6.
  2. Weather the contribution has already been paid to the Welfare Commissioner, if so, whether by cheque, money order or cash and details thereof.

Signature of the employer. Form 'B'

[See Rule 3(5)]

Statement of employers' contribution received by the Welfare Commissioner for six months ending on 30th June and 31st December respectively in the year ______________

Class of Establishment

Number of establishment

Amount of employers' contribution received by the Welfare

Commissioner

1

2

3

Rs.

1. Factories

2. Motor Omni bus Service

3. Shops

4.Commercial establishments

5. Residential hotel

6. Restaurants

7. Eating house

8. Theatres

9. Other place of public amusement or entertainment

TOTAL

Signature of the

Welfare Commissioner

Form C

(See Rule 7)

I. Cash Book of the Office of the........

Receipts

Date of receipt

Sl.

No. of receipt

Details of the Receipts

P.O. Deposit

Particulars of receipts

Receipt

No.

Bank deposit

Cash

Bank

Provisional receipts

Other deposits

R.B.F.

1

2

3

4

5

6

7

8

9

10

Rs. P.

Rs. P.

Rs. P.

Rs. P.

Rs. P.

Opening Balance

Expenditure

Date of Expenditure

Sl. No. subvoucher

Details of the payments

P.O. Deposit

Particulars

of

expenditure

Voucher No.

Bank deposit

Cash

Bank

Provisiona l receipts

Other deposits

R.B.

11

12

13

14

15

16

17

18

19

20

Rs. P.

Rs. P.

Rs. P.

Rs. P.

Rs. P.

Total expenditure

Total Receipts............. Total Expenditure.......... Grand Total.......... Closing Balance.......... Grant Total..........

  1. Classified Abstract of Pay and Allowance in Receipt of....... for the month of......20.....

Serial No.

Voucher No.

Date

Bill No.

Officers

Leave Salary Prov.

Pay

Allow.

Pay

Allow.

1

2

3

4

5

6

7

8

Super visoryc um-

Admin istrative S taff

Programme for

Administrative Staff

Community

necessities and educational staff

Total

Pay

Allow.

Pay

Allow.

Pay

Allo w.

Pay

Allow.

9

10

11

12

13

14

15

16

T.A. For staff

T.A. For members of the

Board

Leave

Travel

Concession

Total of each voucher

Initials

On tour

On

transfer

Clerk

Supdt.

17

18

19

20

21

22

23

  1. Classified Abstract of Contingent Expenditure of the....Programme Expenditure

Serial No.

Voucher No.

Bill No.

Date

Place

Community Necessity

Creche

Nursery

School

N.R.

R.

1

2

3

4

5

6

7

8

Tailoring

R.E.S.

Home

Subsidiary

Sewing

Reading

Classes

N.R.

R.

Industries

occupations

for women

Machines

Rooms

Centres

9

10

11

12

13

14

15

Libraries Centres

Workers Education

Entertainment and other

Music and

Socials etc.

National Special Days

Dramas and Drama

Festivals

Exhibition

16

17

18

19

20

21

22

R ecreation

Games and Sports

Matches

Visual

Instruction

Cinema

Show

Scouts and

Guides

Excursions and Tours

Conveyance and

Refreshment

Entry Fees

First Aid

Prizes

23

24

25

26

27

28

29

30

Office/centre.............. for the Month of........20......

Facilities of Conducting Programmes

Games

materials

Repairs to play app. and

playgrounds

N.

R.

Annual

Sports and Misc.

Furniture

Electricity and lighting

N.R.

R.

31

32

33

34

35

36

37

Rent Rates and Taxes

Postage Exchange and

Printing and Stationery

Vehicles

Bank Commission

N.R.

R.

N.R.

R.

38

39

40

41

42

43

Serial No.

Voucher No.

Date

Bill No.

1

2

3

4

Central Office............................

Divisional Office.......................

Development Zone Office.........

Circle Office.............................

..................................................

..................................................

..................................................

...................................................

Expenditure during the month of...................

Add: Previous Progressive Expenditure upto............

Adjustments

[Debit

[Credit

Progressive expenditure upto........................

And Allowances for the Month of..........20..........

Officer

Leave Salary Provision

Supervisory-cum-

Administrative Staff

Programme for

Administrative Staff

Pay

Allow

Pay

Allow

Pay

Allow

Pay

Allow

5

6

7

8

9

10

11

12

Community necessities and

educational staff

Total

Pay

Allow

Pay

Allow

13

14

15

16

Central office........................................

Divisional office....................................

development Zone

Office......................

Circle Office.......................................... ...............................................................

...............................................................

............................................................... ...............................................................

Expenditure during the month of.............

Add: Previous Progressive Expenditure upto..............

Adjustments [Debit

[Credit

Progressive expenditure upto..............

T.A. for staff

T.A. for members

of the

Board

Leave

Travel

Concession

Total of each voucher

Initials

On tour

On

transfer

Clerk

Supdt.

17

18

19

20

21

22

23

VI. Consolidated Abstract of Contingent Programme

Serial No.

Voucher No.

Bill No.

Date

Place

1

2

3

4

5

Expenditure during the month of...................

Add: Previous Progressive Expenditure upto............

Adjustments

[Debit

[Credit

Progressive expenditure upto........................

Expenditure for the month of........................

Expensiture

Community necessity

Tailoring Classes

R.E.S.

Home

Industries

Subsidiary occupation for women

Creche

Nursery School

N.R.

R.

N.R.

R.

6

7

8

9

10

11

12

13

Sewing Machines

Reading Rooms at Centres

Libraries at Centres

Workers Education

14

15

16

17

Expenditure during the month of.............

Add: Previous Progressive Expenditure upto..............

Adjustments [Debit

[Credit

Progressive expenditure upto..............

Entertainment and other recreation

Music and

Socials etc.

National

Special

Days

Dramas and

Drama

Festivals

Exhibition

Visual Instruction

Cinema

Show

Scouts and

Guides

Excursions and Tours

18

19

20

21

22

23

24

25

Games and Sports

Matches

Conveyance and Refreshment

Entry Fees

First Aid

Prizes

26

27

28

29

30

Expenditure during the month of.............

Add: Previous Progressive Expenditure upto..............

Adjustments [Debit

[Credit

Progressive expenditure upto.............. Office/Centre.............

For the month of...............

Facilities for Conducting Programme

Games

materials

Repairs to play app.

and

playgrounds

N.R.

Annual

Sports and Misc.

Furniture

Electricity and lighting

N.R.

R.

31

32

33

34

35

36

37

Rent Rates and Taxes

Postage

Exchange and

Bank

Commission

Printing and Stationery

Vehicles

N.R.

R.

N.R.

R.

38

39

40

41

42

43

Expenditure during the month of.............

Add: Previous Progressive Expenditure upto..............

Adjustments [Debit

[Credit

Progressive expenditure upto..............

Special item

Other Miscellaneous

Maintenance of Buildings and repairs

Replacement of Radio and Musical

Instruments

Other

Miscellaneous

Home

Nursing

Conveyance

Daily

Wages

44

45

46

47

48

49

50

Expenditure during the month of.............

Add: Previous Progressive Expenditure upto..............

Adjustments [Debit

[Credit

Progressive expenditure upto..............

Repairs

Administrative Contingency

Provident

Fund

Contribution

Gratuity

Payment

Loans and

Advances

51

52

53

54

55

56

57

Expenditure during the month of.............

Add: Previous Progressive Expenditure upto..............

Adjustments [Debit

[Credit

Progressive expenditure upto..............

Investigation Claims

Legal fees

Grantin-aid

Total

Initials

Clerk/Supdt.

58

59

60

61

62

63

64

Serial No.

Particulars of students

Year of deposit

D.

Receipts

Name

Address

D.A.R.

Receipt

No. and date

Amount

1

2

3

4

5

6

7

Initials

Withdrawals

Initials

Voucher No.

Amount

8-11

8-11

8-11

8-11

  1. Deposit Account for the Workers' Club of Labour Welfare Centre at.................Dr.

Date

Voucher No.

Particulars

Reference No.

Amount

Initials

Cr.

Date

Particulars

Reference No.

DAR No.

Amount

Initials

  1. Unpaid Accumulations Account Vide Section 3(1) of the Act for the Month of..........20....

Payments

Date

Particulars

Name of the persons

Payment made from amounts

received during quarter

L.F.

V.No.

Amount

Receipts

Date

Particulars

Receipts No.

L.F.

Amount

  1. Register of Quarterly Receipts of Unpaid Accumulations from theName of Establishment.............

Account No. ..................

Period and particulars (Wage

Amount received

Period)

Referred of

notice if issued

Unpaid

accumulations

Interest

Receipt No. and date

First Quarter ending 31st

March, 20

Second Quarter ending 30th

June, 20

Third Quarter ending 30th

Sept., 20

Fourth Quarter ending 31st

Dec., 20

Bonus for the year declared on

Total

First Quarter ending 31st

March, 20

Second Quarter ending 30th

June, 20

Third Quarter ending 30th

Sept., 20

Fourth Quarter ending 31st

Dec., 20

Bonus for the year declared on

Total

First Quarter ending 31st

March, 20

Second Quarter ending 30th

June, 20

Third Quarter ending 30th

Sept., 20

Fourth Quarter ending 31st Dec., 20

Bonus for the year declared on

Total

Factory Establishment and Publication of Notices

File No. ..............

Address Factory

Registered Office

1st Year

Section 6A

Name of the Establishment................ Account No. .....................

File No............... Address: Factory/Registered Office..................

Seria l No.

Name of the claimant

Refund Order No. and date

Voucher

No. and date

Payment of unpaid accumulations from receipts

As on

Quarter ending

Quarter ending

Quarter ending

Quarter ending

Quarter ending

1

2

3

4

5

6

7

8

9

10

Amount received ..................

Date of first publication.............

Seria l No.

Name of the claimant

Payment of unpaid accumulations from receipts

Quarter ending

Quarte r ending

Quarter ending

Quarter ending

Quarter ending

Quarter ending

Quarter ending

Remarks

1

2

11

12

13

14

15

16

17

18

Amount received ..................

Date of first publication.............

Form D

[See Rule 27(1)(a)]

Register of Wages

Name of the establishment................ For the month of..................

Sl.

No.

Name of employee

Ticket and

Badge No.

Occupation

Amount payable during the month

Basic

Wages

Over time

Dearness

Allowance and other allowances

Bonus

1

2

3

4

5

6

7

8

Amount deducted during the month

Amounts actually paid during the month

Fines

Other deductions

Basic

Wages

Over time

Dearness Allowance and other allowances

Bonus

9

10

11

12

13

14

Overtime Basic wages

Dearness allowances and other allowances

Bonus

15

16

17

18

Form E

[See Rule 27(1)(b)]

Register for Fines and Unpaid Accumulations for the Year, 20... Name of the Establishments.................

Quarter ending

31st

March

Quarter ending

30th June

Quarter ending

30th

September

Quarter ending

31st

October

1.

Total realisation under fines

2.

Total amount becoming unpaid accumulations of

(i) Basic wage

(ii) Overtime

(iii) Dearness Allowance and other allowances

Total of (1), (2)

Reference copy from the firm’s resource library, saved on 26 October 2026. Laws, rates and notifications change — for the current position on your matter, please talk to us. Back to the Knowledge Bank.