Govt. of India, Ministry of Labour & Employment

 

 

FORMS UNDER ISMW(RECS) ACT,1979

 

FORM I

 

(Refer Rule 3(1)]

 

Application for Registration of Establishments Employing Migrant Workmen

 

1.     Name and location of the Establishment:

 

2.     Postal address of the Establishment:

                                

3.     Full name and address of the principal Employer (furnish father's/ husband’s name in the case of individuals):

 

4.     Names and addresses of the directors/ particular partners (in case of companies and firms):

 

5.     Full name and address of the manager or person responsible for the supervision and control of the Establishment:

 

6.     Nature of work carried on in the Establishment:

 

7.     Particulars of Contractors and Migrant Workmen:

 

(a)   Names and addresses of Contractors.

 

(b)    Nature of work for which migrant workmen are to be recruited or are employed:

 

(c)   Maximum number of migrant workmen to be employed on any day through each contractor:

 

(d) Estimated date of commencement of work under each contractor:

 

(e) Estimated date of termination of employment of migrant workmen under each      

      contractor:

 

8.     Particulars of crossed demand draft ……………………………… (Name of the Bank, Amount, Number and Date):

 

            I hereby declare that the particulars given above are true to the best of my knowledge and belief.

 

 

Principal Employer.

Seal and Stamp

 

 

Office of the    Registering Officer

                                                                                                                                                            Date of receipt of application:

 

 

 

 

 

FORM V

[Refer Rule 7(2)]

Application for Licence for Employment

 

1.     Name and address of the contractor (including his father's/ husband’s name in case of individuals):

 

2.     Date of birth and age (in case of individuals):

 

3.     Particulars of Establishment where migrant workmen is to be employed-

 

(a)   Name and address of the establishment ;

(b)   Type of business, trade, industry, manufacture or occupation, which is carried on in the establishment ;

(c)   Number and date of Certificate of Registration of the establishment under the Act ;

(d)   Name and address of the Principal Employer.

 

4.     Particulars of migrant workmen-

 

(a)    Nature of work in which migrant workmen are employed or are to be employed in the establishment:

(b)   Duration of the proposed contract work (give particulars of proposed date of commencing and ending):

(c)    Name and address of the agent or manager of the contractor at the work-site:

(d)    Maximum number of migrant workmen proposed to be employed  on the establishment on any date:

(e)    Names and addresses of the Directors/ Partners (in case of companies and firms):

(f)    Name(s) and address(es) of the person(s) in charge of and responsible  to the company/ firm for the conduct of the business of the company/ firm, as the case may be:

 

5.     Whether the contractor was convicted of any offence within the preceding five years. If so, give details:

 

6.     Whether there was any order against the contractor revoking or suspending licence or forfeiting security deposits in respect of an earlier contract. If so, the date of such order:

 

7.      Whether the contractor has worked in any other establishment within the past five years. If so, give details of the Principal Employer, Establishment, and nature of work:

 

8.     Whether a certificate by the Principal Employer, in Form VI is enclosed:

 

9.      Amount of licence fee paid………………., No. of crossed demand draft and date:

 

10.  Amount of security deposit, if any:

 

 

Declaration

 

I hereby declare that the details given above are correct to the best of my

knowledge and belief.

 

Signature of the Applicant (Contractor)

Place ………………….

Date……………………

                                                  

Note.-The application should be accompanied by a crossed demand draft showing the payment of prescribed fee and security deposit, if any, certificate in Form VI from the principal employer.

                                                                                                                                                _____

(To be filled in the office of the Licensing Officer)

Date of receipt of the application with crossed demand draft for fees

 

 

Signature of the Licensing Officer.

 

 

 

 

Form VI

[Refer Rule 7(3)]

 

Form of Certificate by Principal Employer

 

Certified that I have engaged the applicant (name of the contractor) as a contractor in my establishment. I undertake to be bound by all the provisions of the Inter-state Migrant Workmen (Regulation of Employment & Conditions of Service) Act, 1979 and the Inter-state Migrant Workmen (Regulation of Employment & Conditions of Service) Central Rules, 1980, in so far as the provisions are applicable to me in respect of the employment of migrant workmen by the applicant in my establishment.

 

 

Place:                                                                            Signature of Principal Employer

Date:                                                                        Name and address of the establishment

 

 

 

FORM VII

[Refer Rule 10(2)]

Application for Adjustment of Security Deposit

                                                                                                                                   

Name and address of the Contractor

No. and date of application for fresh licence

Date of expiry of previous licence

Whether the previous licence of the contractor was suspended or revoked

(1)

(2)

(3)

(4)

 

 

 

 

 

 

No. and date of the demand draft of security deposit in respect of the previous licence

Amount of previous security deposit

Amount of security deposit for fresh licence

No. and date of crossed demand draft of the balance security deposit deposited with the fresh application

(5)

(6)

(7)

(8)

 

 

 

 

 

 

No. and date of certificate of registration of the establishment in relation to which the fresh licence is applied for

Name and address of the principal employer

Particulars of fresh application

Remarks

(9)

(10)

(11)

(12)

 

 

 

 

 

 

 

 

Place:

Date:                                       

Signature of the Applicant.

 

 

 

 

 

 

 

 

 

FORM IX

[Refer Rule 15(2)]

 

Application for Renewal of Licence

 

1.     Name and address of the contractor.

 

2.     Number and date of the licence.

 

3.     Date of expiry of the previous licence.

 

4.     Whether the licence of the contractor was suspended or revoked.

 

5.     Number and date of the crossed demand draft enclosed.

 

Place…………………………...

                                               

Signature of the Applicant

Date……………………………

 

                                                                                                                                               

 

(To be filled in the Office of the Licensing Officer)

 

Date of receipt of the application with crossed demand draft number and date.

 

 

 

                                                            Signature of the Licensing Officer

 

 

 

 

 

 

 

FORM XII

[Refer Rule 48]

Register of Contractors

 

 

1.     Name and address of the Principal Employer ………………………………………………………...

 

2.     Name and address of the establishment …………………………………………………………………

 

Sl. No.

Name and address of contractor

Nature of work on contract

Location of contract work

Period of contract

Maximum No. of migrant workmen employed by contractor

From

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

           

 

 

 

 

 

FORM XIII

[Refer Rule 49]

 

Register of Workmen Employed by Contractor

 

Name and address of the contractor……………………………………………………………

 

Name and address of establishment …………………………………………………………..

 

Name and address of the establishment in/ under which migrant workmen are employed …………………………………………………………………………………….

 

 

 

Name and address of Principal Employer ……………………………………………………..

 

 

 

 

 

 

 

 

Sl. No.

Name and surname of migrant workman

Age and Sex

Father's/
Husband's name

Nature of Employment/ Designation

Permanent home address of migrant workman (Village and Tahsil/ Taluk and District)

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Local Address

Date of Commencement of employment

Signature or thumb-impression of migrant workman

Date of termination of employment

Reasons for termination

Remarks

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Signature of contractor

or his authorized representative

 

 

 

 

 

FORM XIV

[Refer Rule 50]

 

Service Certificate

 

Name and address of contractor

………………….….

Name and address of establishment in/

 

 

under which migrant workmen are employed ………………………….…………

 

 

 

 

 

 

 

…………………………………………………

Nature and location of work

..

………………….….

 

Name and address of the migrant workman

 

Name and address of Principal Employer

 

..

 

..

 

..

………………….….

…………………...…………………...………..

 

 

…………………...…………………...………..

Age or Date of Birth

..

………………….….

 

Identification Marks

 

………………….….

 

Father's / Husband's name

..

………………….….

 

 

 

 

Sl. No.

Total period which employed

Nature of work done

Rate of wages (with particulars of unit in case of piece work)

Remarks

From

To

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

                                                                       

 

 

 

Signature of Contractor

or his authorized representative                         

 

 

 

 

 

 

 

 

Form XV

[Refer Rule 51(1)]

DISPLACEMENT AND OUTWARD JOURNEY ALLOWANCE SHEET

 

Name and address of the contractor:

 

Name and address of the Principal Employer:

 

Name and address of the establishment:

 

Month and Year:

 

1

Serial No.

2

Name of the migrant workman

3

Father’s/ husband’s name

4

Permanent home address indicating the State

5

Place and address of residence in home State

6

Designation

7

Rate of Wages

8

Wages payable in a month

9

Place of recruitment

10

Place of work with address indicating the State

11

Railway Station/ Bus Stand nearest to the place of residence

12

Railway Station/ Bus Stand nearest to the place of work

13

Date and time of commencement of journey from  the place of residence

14

Expected date and time of arrival at the place of work

15

Details of modes of journeys from the place of residence in the home State to the place of work

16

Amounts of bus fare and/ or second class train fare and/ or other journey expenses separately as the modes of journey indicated in Column 15

17

Total of amounts indicated in Column 16

18

Amount of Displacement Allowance

19

Amount of Outward Journey Allowance

20

Wages for outward journey period

21

Total amount paid

22

Date on which paid

23

Signature or thumb impression of the migrant workman

24

Actual date and time of arrival at the place of work

25

Balance wages for outward journey, if any, payable

26

Date of payment of the balance wages indicated in Column 25

27

Signature or thumb impression of the migrant workman

28

Remarks

 

 

 

 

 

 

Form XVI

[Refer Rule 51(1)]

RETURN JOURNEY ALLOWANCE REGISTER

 

Name and address of the contractor:

 

Name and address of the Principal Employer:

 

Name and address of the establishment:

 

Month and Year:

 

1

Serial No.

2

Name of the migrant workman

3

Father’s/ husband’s name

4

Permanent home address indicating the State

5

Place and address of residence in home State

6

Designation

7

Rate of Wages

8

Place of work   

9

Railway Station/ Bus Stand nearest to the place of work

10

Railway Station/ Bus Stand nearest to the place of residence in home State

11

Date and time of commencement of journey from  the place of work

12

Expected date and time of arrival at the place of residence in home State

13

*Expected modes of journeys from the place of work to place of residence in the home State

14

Amounts of bus fare and/ or second class train fare and/ or other journey expenses separately as the modes of journey indicated in Column 13

15

Total of amounts indicated in Column 14

16

Amount of Return Journey Allowance

17

Wages for return journey period

18

Total amount paid

19

Date on which paid

20

Signature or thumb impression of the migrant workman

21

Remarks

 

*Indicate separately different modes of journey.

Note: Entries are to be made against each individual inter-state migrant workman.

 

 

Signature of the Contractor

 or his authorized representative

Date:

 

 

 

 

 

 

 

 

 

 

 

FORM XVII

 

[Refer Rule 52(2)(a)]

 

Muster Roll

 

Name and address of contractor

………………….….

Name and address of establishment in/

 

 

under which inter-state migrant workmen are employed …………………….…………

 

 

…………………………………………………

Nature and location of work

..

………………….….

Name and address of Principal Employer…

 

 

…………………………………………………

 

………………….….

For the month of …………...………………..

 

…………………………………………………

       

 

 

 

 

 

Dates

 

Sl. No.

Name of migrant workman

Father's / Husband's name

Sex

1   2   3   4   5

Remarks

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM XVIII

[Refer Rule 52(2)(a)]

Register of Wages

 

Name and address of Contractor

Name and address of Establishment in / under

…………………………………………………………...

which inter-state workmen are employed ……………………………….………………………….

Nature and location of works

…………………………………………………………...

 

 

…………………………………………………………...

Name and address of Principal

 

Employer ……………………………………………

…………………………………………………………

 

Wage period:   …..………………………………...

 

 

Sl. No.

Name of inter-state migrant workman

Serial No. in the register of workman

Designation / nature of work

No. of days worked

Units of works done

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

Daily rate of wages/piece rate

Amount of wages earned

Basic wages

Dearness Allowances

Overtime

Other cash payments (Nature of payment to be indicated)

Total

7

8

9

10

11

12

 

 

 

 

 

 

 

 

Deductions, if any, (indicate nature)

Net amount paid

Signature / Thumb impression of inter-state migrant workman

Initial of contractor or his authorized representative

13

14

15

16

 

 

 

 

 

 

 

 

 

 

FORM XIX

[Refer Rule 52(2)(c)]

Register of Deductions for Damage or Loss

 

Name and address of Contractor ……………………

Name and address of Establishment in / under

…………………………………………………………..

which inter-state migrant workmen are employed ……………………………….………………………….

 

…………………………………………………………...

Name and location of work ………………………….

Name and address of Principal Employer

…………………………………………………………...

…………………………………………………………...

 

Sl. No.

Name of inter-state migrant workman

Father's / Husband's name

Designation/ Nature of Employment

Particulars of damage or loss

Date of damage or loss

Whether inter-state migrant workman showed cause against deduction

1

2

3

4

5

6

7

 

 

 

 

 

 

 

 

 

 

 

 

Date of recovery

 

Name of person in whose presence employee's explanation was heard

Amount of deduction imposed

No. of installments

First installment

Last installment

Remarks

8

9

10

11

12

13

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM XX

[Refer Rule 52(2)(c)]

Register of Fines

 

Name and address of Contractor ……………………

Name and address of Establishment in / under

…………………………………………………………..

which inter-state migrant  are employed  ………………………………..………………………….

 

…………………………………………………………...

Name and location of work ………………………….

Name and address of Principal Employer

…………………………………………………………...

…………………………………………………………...

 

Sl.

No.

Name of inter-state migrant workman

Father's/ Husband name

Designation / nature of employment

Act/ Omission for which fine imposed

Date of offence

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

Whether inter-state migrant workman showed cause against fine

Name of person in whose presence employee's explanation was heard

Wage periods and wages payable

Amount of fine imposed

Date on which fine realized

Remarks

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM XXI

[Refer Rule 52(2)(c)]

Register of Advances

 

Name and address of Contractor ……………………

Name and address of establishment in / under

…………………………………………………………..

which inter-state migrant workmen are employed ……………………………….………………………….

 

…………………………………………………………...

Name and location of work ………………………….

Name and address of Principal Employer

…………………………………………………………...

…………………………………………………………...

 

Sl.

Name of inter-state migrant workman

Father's/ Husband name

Nature of employment/ Designation

Wage period and wages payable

Date & amount of advance given

1

2

3

4

5

6

 

 

 

 

 

 

 

 

 

Purpose(s) for which advance made

No. of installments by which advance to be repaid

Date & amount of each installment repaid

Date on which last installment was repaid

Remarks

7

8

9

10

11

 

 

 

 

 

 

 

 

 

 

 

 

FORM XXII

 

[Refer Rule 52(2)(c)]

 

Register of Overtime

 

Name and address of Contractor ……………………

Name and address of establishment in / under

…………………………………………………………..

which inter-state migrant workmen are employed ……………………………….………………………….

 

…………………………………………………………...

Name and location of work ………………………….

Name and address of Principal Employer

…………………………………………………………...

…………………………………………………………...

 

Sl. No.

Name of inter-state migrant workman

Father's / Husband's name

Sex

Designation/ nature of employment

Date on which overtime worked

1

2

3

4

5

6

 

 

 

 

 

 

 

 

Total overtime worked or production in case of piece-rated

Normal rate of wages

Overtime rate of wages

Overtime earnings

 

 

Date on which overtime wages paid

Remarks

7

8

9

10

11

12

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM XXIII

[Refer 45(1)]

Return to be sent by the Contractor to the Licensing Officer

 

                                    Half-Year-Ending……………………………………..

1.

Name and address of the Contractor

..

 

 

2.

Name and address of the establish-

 

 

 

ment

..

 

..

 

..

 

 

3.

Name and address of the Principal

 

 

 

employer

..

 

..

 

..

 

 

4.

Duration of Contract: From ……..to…….

 

 

 

 

5.

No. of days during half year on which-

 

(a)

the establishment of the Principal

 

employer had worked

(b)

the contractor's establishment had

 

worked..                ..                      ..

6.

Maximum number of inter-state migrant workmen employed on any day during the half year:

 

 

Men

Women

 

Children

 

Total

 

 

7.

(i) Daily hours of work and spread over-

 

 

(ii)

(a)

whether weekly holiday

 

 

 

 

observed and on what day-

 

 

 

(b)

If so, whether it was paid for-

 

 

(iii)

No. of man-hours of overtime worked

 

 

8.

Number of man-days worked by-

 

 

Men

Women

 

Children

 

Total

 

 

9.

Amount of wages paid-

*

 

Men

Women

 

Children

 

Total

 

 

10.

Amount of deduction from wages, if any-

 

 

Men

Women

 

Children

 

Total

 

 

11.

Amount of Displacement Allowance paid:

 

 

Men

Women

 

Children

 

Total

 

 

12.

Amount of Outward Journey Allowance paid

 

 

Men

Women

 

Children

 

Total

 

 

13.

Amount of wages for outward journey period paid:

 

 

Men

Women

 

Children

 

Total

 

 

14.

Amount of Return Journey Allowance paid:

 

 

Men

Women

 

Children

 

Total

 

 

15.

Amount of wages for return journey period paid:

 

 

Men

Women

 

Children

 

Total

 

 

16.

Whether the following have been  provided-

 

 

(i)

Residential accommodation

 

 

 

(ii)

Protective clothing

 

 

 

(iii)

Canteen

 

 

 

(iv)

Rest-Room

 

 

 

(v)

Latrines and urinals

 

 

 

(vi)

Drinking water

 

 

 

(vii)

Creche

 

 

 

(viii)

Medical facilities

 

 

 

(ix)

First-Aid

 

 

 

 

(If the answer is 'yes' state briefly standards provided)

 

 

 

 

 

 

 

 

* Wages shall not include wages for periods of outward and return journeys.

 

Place ……………………

 

Signature of Contractor

 

Date ……………………..

                                   

 

 

 

 

 

 

 

 

 

 

FORM XXIV

[Refer Rule 56(2)]

Annual Return of Principal Employer to be sent to the Registering Officer

                                   

Year ending 31st December       

1.     Full name and address of the Principal Employer.

 

2.     Name of Establishment:

(a)   District

(b)   Postal Address

(c)   Nature of operation/industry/work carried on.

 

3.     Full name of the manager or person responsible for supervision and control of the establishment.

 

4.     Number of Contractors who worked in the establishment during the year (Give details in Annexure).

 

5.     Nature of work/operation on which migrant workman was employed.

 

6.     Total number of days during the year on which migrant workman was employed.

 

7.     Total number of man-days worked by migrant workman during the year.

 

8.     Maximum number of workmen employed directly on any day during the year.

 

9.     Total number of days during the year on which direct labour was employed.

 

10.  Total number of man-days worked by directly employed workmen.

 

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.

 

 

 

                                                           

                                                                                                                        Principal Employer

Place ……………………….

 

Date ………………………...

 

 

 

 

 

 

 

ANNEXURE TO FORM

 

Name and address of the Contractor

Period of contract

 

From-To

Nature of work

Maximum number of workers employed by each contractor

No. of days worked

No. of man-days worked

1

2

3

4

5

6