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/ husbands 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/ husbands 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.
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(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
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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 |
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(1) |
(2) |
(3) |
(4) |
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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 |
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(5) |
(6) |
(7) |
(8) |
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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 |
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(9) |
(10) |
(11) |
(12) |
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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
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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 |
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From |
To |
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FORM XIII
[Refer Rule 49]
Register of Workmen Employed by Contractor
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Name and address of the contractor
Name and address of establishment ..
Name and address of the establishment in/ under which migrant workmen are employed . |
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Name and address of Principal Employer .. |
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Sl. No. |
Name and surname of migrant workman |
Age and Sex |
Father's/ |
Nature of Employment/ Designation |
Permanent home address of migrant workman (Village and Tahsil/ Taluk and District) |
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Local Address |
Date of Commencement of employment |
Signature or thumb-impression of migrant workman |
Date of termination of employment |
Reasons for termination |
Remarks |
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11 |
12 |
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Signature of contractor
or his authorized representative
FORM XIV
[Refer Rule 50]
Service Certificate
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Name and address of contractor |
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Name and address of establishment in/ |
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under which migrant workmen are employed . |
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Nature and location of work |
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Name and address of the migrant workman |
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Name and address of Principal Employer |
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... ... .. |
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... ... .. |
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Age or Date of Birth |
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Identification Marks |
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Father's / Husband's name |
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Sl. No. |
Total period which employed |
Nature of work done |
Rate of wages (with particulars of unit in case of piece work) |
Remarks |
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From |
To |
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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:
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1 |
Serial No. |
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2 |
Name of the migrant workman |
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3 |
Fathers/ husbands name |
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4 |
Permanent home address indicating the State |
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5 |
Place and address of residence in home State |
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6 |
Designation |
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7 |
Rate of Wages |
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8 |
Wages payable in a month |
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9 |
Place of recruitment |
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10 |
Place of work with address indicating the State |
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11 |
Railway Station/ Bus Stand nearest to the place of residence |
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12 |
Railway Station/ Bus Stand nearest to the place of work |
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Date and time of commencement of journey from the place of residence |
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14 |
Expected date and time of arrival at the place of work |
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Details of modes of journeys from the place of residence in the home State to the place of work |
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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 |
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17 |
Total of amounts indicated in Column 16 |
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18 |
Amount of Displacement Allowance |
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19 |
Amount of Outward Journey Allowance |
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Wages for outward journey period |
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21 |
Total amount paid |
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22 |
Date on which paid |
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23 |
Signature or thumb impression of the migrant workman |
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Actual date and time of arrival at the place of work |
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Balance wages for outward journey, if any, payable |
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26 |
Date of payment of the balance wages indicated in Column 25 |
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Signature or thumb impression of the migrant workman |
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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:
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Serial No. |
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2 |
Name of the migrant workman |
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3 |
Fathers/ husbands name |
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4 |
Permanent home address indicating the State |
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5 |
Place and address of residence in home State |
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6 |
Designation |
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7 |
Rate of Wages |
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8 |
Place of work |
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9 |
Railway Station/ Bus Stand nearest to the place of work |
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10 |
Railway Station/ Bus Stand nearest to the place of residence in home State |
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11 |
Date and time of commencement of journey from the place of work |
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12 |
Expected date and time of arrival at the place of residence in home State |
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13 |
*Expected modes of journeys from the place of work to place of residence in the home State |
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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 |
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Total of amounts indicated in Column 14 |
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Amount of Return Journey Allowance |
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17 |
Wages for return journey period |
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18 |
Total amount paid |
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19 |
Date on which paid |
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20 |
Signature or thumb impression of the migrant workman |
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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
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Name and address of contractor |
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Name and address of establishment in/ |
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under which inter-state migrant workmen are employed . |
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Nature and location of work |
.. |
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Name and address of Principal Employer |
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. . |
For the month of ... .. |
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Dates |
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Sl. No. |
Name of migrant workman |
Father's / Husband's name |
Sex |
1 2 3 4 5 |
Remarks |
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2 |
3 |
4 |
5 |
6 |
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FORM XVIII
[Refer Rule 52(2)(a)]
Register of Wages
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Name and address of Contractor |
Name and address of Establishment in / under |
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which inter-state workmen are employed . . |
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Nature and location of works |
... |
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... |
Name and address of Principal |
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Employer
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Wage period: .. ... |
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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 |
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1 |
2 |
3 |
4 |
5 |
6 |
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Daily rate of wages/piece rate |
Amount of wages earned |
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Basic wages |
Dearness Allowances |
Overtime |
Other cash payments (Nature of payment to be indicated) |
Total |
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8 |
9 |
10 |
11 |
12 |
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Deductions, if any, (indicate nature) |
Net amount paid |
Signature / Thumb impression of inter-state migrant workman |
Initial of contractor or his authorized representative |
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14 |
15 |
16 |
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FORM XIX
[Refer Rule 52(2)(c)]
Register of Deductions for Damage or Loss
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Name and address of Contractor |
Name and address of Establishment in / under |
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which inter-state migrant workmen are employed . . |
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... |
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Name and location of work . |
Name and address of Principal Employer |
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... |
... |
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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 |
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1 |
2 |
3 |
4 |
5 |
6 |
7 |
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Date of recovery |
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Name of person in whose presence employee's explanation was heard |
Amount of deduction imposed |
No. of installments |
First installment |
Last installment |
Remarks |
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9 |
10 |
11 |
12 |
13 |
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FORM XX
[Refer Rule 52(2)(c)]
Register of Fines
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Name and address of Contractor |
Name and address of Establishment in / under |
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which inter-state migrant are employed .. . |
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... |
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Name and location of work . |
Name and address of Principal Employer |
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... |
... |
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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 |
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1 |
2 |
3 |
4 |
5 |
6 |
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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 |
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7 |
8 |
9 |
10 |
11 |
12 |
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FORM XXI
[Refer Rule 52(2)(c)]
Register of Advances
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Name and address of Contractor |
Name and address of establishment in / under |
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which inter-state migrant workmen are employed . . |
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... |
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Name and location of work . |
Name and address of Principal Employer |
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... |
... |
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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 |
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1 |
2 |
3 |
4 |
5 |
6 |
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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 |
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7 |
8 |
9 |
10 |
11 |
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FORM XXII
[Refer Rule 52(2)(c)]
Register of Overtime
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Name and address of Contractor |
Name and address of establishment in / under |
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.. |
which inter-state migrant workmen are employed . . |
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... |
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Name and location of work . |
Name and address of Principal Employer |
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... |
... |
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Sl. No. |
Name of inter-state migrant workman |
Father's / Husband's name |
Sex |
Designation/ nature of employment |
Date on which overtime worked |
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1 |
2 |
3 |
4 |
5 |
6 |
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Total overtime worked or production in case of piece-rated |
Normal rate of wages |
Overtime rate of wages |
Overtime earnings
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Date on which overtime wages paid |
Remarks |
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7 |
8 |
9 |
10 |
11 |
12 |
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FORM XXIII
[Refer 45(1)]
Return to be sent by the Contractor to the Licensing Officer
Half-Year-Ending ..
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1. |
Name and address of the Contractor |
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2. |
Name and address of the establish- |
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ment |
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3. |
Name and address of the Principal |
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employer |
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4. |
Duration of Contract: From ..to . |
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5. |
No. of days during half year on which- |
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the establishment of the Principal |
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employer had worked |
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(b) |
the contractor's establishment had |
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worked.. .. .. |
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6. |
Maximum number of inter-state migrant workmen employed on any day during the half year: |
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Men |
Women |
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Children |
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Total
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7. |
(i) Daily hours of work and spread over- |
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(ii) |
(a) |
whether weekly holiday |
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observed and on what day- |
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(b) |
If so, whether it was paid for- |
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(iii) |
No. of man-hours of overtime worked
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8. |
Number of man-days worked by- |
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Men |
Women |
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Children |
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Total
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9. |
Amount of wages paid- |
* |
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Men |
Women |
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Children |
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Total
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10. |
Amount of deduction from wages, if any- |
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Men |
Women |
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Children |
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Total
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11. |
Amount of Displacement Allowance paid: |
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Men |
Women |
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Children |
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Total
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12. |
Amount of Outward Journey Allowance paid |
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Men |
Women |
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Children |
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Total
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13. |
Amount of wages for outward journey period paid: |
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Men |
Women |
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Children |
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Total
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14. |
Amount of Return Journey Allowance paid: |
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Men |
Women |
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Children |
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Total
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15. |
Amount of wages for return journey period paid: |
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Men |
Women |
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Children |
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Total
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16. |
Whether the following have been provided- |
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(i) |
Residential accommodation |
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(ii) |
Protective clothing |
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(iii) |
Canteen |
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(iv) |
Rest-Room |
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(v) |
Latrines and urinals |
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(vi) |
Drinking water |
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(vii) |
Creche |
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(viii) |
Medical facilities |
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(ix) |
First-Aid |
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(If the answer is 'yes' state briefly standards provided)
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* Wages shall not include wages for periods of outward and return journeys.
Place |
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Signature of Contractor |
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Date .. |
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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
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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 |
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1 |
2 |
3 |
4 |
5 |
6 |
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