FORMS UNDER PW(ATS) Rules, 1968
Form I
(See Rule 3)
Notice of opening, abandonment, discontinuance, resumption, and change in the ownership, addresses etc.
From
2. -------------------------------
3. ---------------------------------
4. ----------------------------------
5. To,
The Regional Labour Commissioner (C) --------------------------------- Sir, I have to furnish the following particulars in respect of *_______________ at ______________ establishment of ________________ (Owner)1. In the case of change of name of establishment-
Old name of establishment
Date of change2(a) Situation of the establishment: Village
Police Station Sub Division (Taluka)
District State
(b) In the case of new establishment, particulars of situation of establishment :
Post Office Telegraph office
Railway station Rest House
Post Office Telegraph office Railway station Rest House (Give distance therefrom) Means of traveling 5. 3 (a) Name and postal address of Present/ previous#(i) Owner
(ii) Managing Agent, if any
(iii) Agent, if any
(iv) Manager
(v) In case of change, date of change
4. Date on which it is intended to open/ resume/ abandon/ discontinue # the establishment
5. Actual date of opening / reopening/ abandonment/ discontinuance #of the establishment
6. No. of persons likely to be affected
Yours faithfully
Signature
Designation:
Owner/Agent/Manager
Date:
INSTRUCTIONS:* Mention the matter to which the notice refers
# Delete whatever is not applicable.
@ To be filled in only when the notice refers to a change and only against the item in respect of which notice is given.
Form II
(See Rule 2)
Register of Fines
Part I
Railway – Department/Division/District/Factory
Sl. No. |
Nature of employment |
Rate of wages |
Wages earned during the wage-period |
Act or omission for which fine imposed |
Date and amount of fine imposed |
Date on which fine realized |
Remarks |
||
Name of employed person |
Father’s or Husband’s name |
||||||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
|
|
|
|
|
|
|
|
|
|
Part- II
Particulars of disbursement of Fines
Date of disbursement |
Remarks |
||
Amount of disbursement |
Purpose for which amount disbursed |
||
1 |
2 |
3 |
4 |
|
|
|
Form III
(See rule 5)
Register of deductions for damage or loss caused to the employer by the neglect or
default of the employed persons
Name of establishment ______________________
Sl. No. |
Nature of employ-ment |
Damage or loss caused and its value |
Whether workman showed cause against fine or not, if so, enter date |
The name of the person in whose presence a workman’s explanation is heard in respect of an employee engaged by a contractor |
Date and amount of deduction imposed |
No. of installments, if any |
Date on which total amount realized |
Remarks |
||
Name of employed person |
Father’s or Husband’s name |
|||||||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
|
|
|
|
|
|
|
|
|
|
|
Form IV
(See rule 6)
Muster Roll
Name of Establishment________________Name and address of employer___________ Location_____________________ Wage period from____________to ______ Post office _________________
Sl. No. |
Father’s/ Husband’s name |
Daily attendance/ No. of units worked 123456789 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |
Total attendance / Total no. of units worked |
Remarks |
||
Name of employed person |
Designation |
|||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
|
|
|
|
|
|
|
Form V
(See rule 6)
Register of Wages
Name of Establishment__________________Name & address of employer___________
Location_____________________
Sl. No |
Name of employed person |
Designation |
Father’s/ Husband’s Name |
Total attendance/ no. of units worked |
Rates of wages |
Wages earned |
Total |
|||||
Basic |
DA |
Other allowance |
Basic |
DA |
O.T. |
Other allowances |
||||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
8 |
10 |
11 |
12 |
|
|
|
|
|
|
|
|
|
|
|
|
|
Deduction from Wages on account of |
Other deductions |
Other deductions |
Net amount payable |
Acquittance with date |
Remarks |
||||
Fines |
Damage or loss |
Loss caused to the employer by neglect or default of employed person |
Amenities/ services/ House Rent |
Provident Fund/ Income Tax/ Postal Insurance/Co.op.Soc. |
|||||
13 |
14 |
15 |
16 |
17 |
18 |
19 |
20 |
21 |
22 |
|
|
|
|
|
|
|
|
|
|
Form VI
(See rule 6)
Muster roll cum Register of Wages
Name of Establishment__________________Name & address of employer___________
Location_____________________
Sl. No |
Name of employed person |
Designation |
Father’s/ Husband’s Name |
Daily attendance / no. of units worked 1234567 |
Total attendance/ no. of units worked |
Rates of wages |
Wages earned |
Total |
|||||
Basic |
DA |
Other allowance |
Basic |
DA |
O.T. |
Other allowances |
|||||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
8 |
10 |
11 |
12 |
13 |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Deduction from Wages on account of |
Deductions from wages on account of other deductions |
Total deductions |
Net amount payable |
Acquittance with date |
Remarks |
||||
Fines |
Damage or loss |
Loss caused to the employer by neglect or default of employed person |
Amenities/ services/ House Rent |
Provident Fund/ Income Tax/ Postal Insurance/Co.op.Soc. |
|||||
13 |
14 |
15 |
16 |
17 |
18 |
19 |
20 |
21 |
22 |
|
|
|
|
|
|
|
|
|
|
Form VII
(See Rule 11(1)(ii))
Notice of rates of wages and scales of allowances payable to employed persons
Name of establishment_________________
Sl. No. |
Rate of Wages Rs. P. |
Rate of allowances, if any |
Remarks |
||
Class of employees or description of work |
Particulars of Wage period |
||||
1 |
2 |
3 |
4 |
5 |
6 |
|
|
|
|
|
|
Form VIII
(See Rule 16)
Annual Return
Return for the year ending 31st December ____
1.(a) Name of the Establishment, location and postal address:
** (b) Name and address of the Manager / Contractor: **(c) Name of the Company/ Firm owning the establishment and full address of its registered office: ** (d) Name and residential address of the Managing Agent/Director/ Partner in charge of the day to day affairs of the establishment: **(e) Name and address of the person, if any, other than the Manager/Contractor, who is responsible for payment of wages in terms of the proviso to section 3 of the Payment of Wages Act, 1936 :
2. Number of days worked during the year:
*3. (a) Number of mandays worked during the year:
_________________________________________________________
Persons receiving less than ‘[Rs.10,000/-] pm
Adults Children # (b) Average daily no. of persons receiving less than ‘[Rs.10,000/-] pm Employed during the year Adults Children (c) Gross amount paid as remuneration to persons getting less than ‘[Rs.10,000/-] pm including deductions under sec.7(2) is ____________ of which the amount due to profit sharing bonus is __________ and that due to ## money value of concession is ___________
4. Total wages paid including deductions under sec. 7(2) on the following accounts:- (for Persons receiving less than ‘[Rs.10,000/-] pm) (a) Basic wages including overtime wages and non profit sharing bonus. (b) Dearness and other allowances in cash (c) Arrears of pay in respect of previous year paid during the year _______________________________________________________________
( for Persons receiving less than [Rs.10,000/-] pm)
No. of cases
Amount
(a) Fines
(b) Deductions for damage or loss
(c) Deductions for breach of contract
6.Disbursement from the fines fund:-(Purpose and amount)
(a)
(b)
7. Balances of fines fund in hand at the end of the year _________
Signature
Designation
* This is the aggregate number of attendances during the year.
# The average daily number of persons employed during the year is obtained by dividing
aggregate number of attendances during the year by the number of working days.
##Money value of concessions should be obtained by taking the difference of the cost
price paid by the employer and the actual price paid by the employees for supplies of
essential given free or at concessional rates.
** Strike of whichever is not applicable.
Form IX
[See Rule 17(3)]
Register of advances made to employed persons
Name of Establishment
Sl. No |
Name of employed person |
Father’s or husband’s name |
Nature of employment |
Earning during a wage period |
Date and amount of advance |
Purpose for which advance made |
Installments for repayment of advances |
Date of installments repaid |
Date of which total amount repaid |
Signature or thumb impression of the worker or remarks |
|
No. of installments |
Amount of each installment |
||||||||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
|
|
|
|
|
|
|
|
|
|
|
|
Form X
[See rule 18(3)]
Register of loans granted to the employed persons for house building or other approved purposes
Sl. No |
Name of employed person |
Father’s or husband’s name |
Nature of employment |
Amount of loan |
Date and amount of granted |
Purpose for which granted |
Installments for repayment of loan |
Date of installments repaid |
Date of which total amount repaid |
Signature or thumb impression of the worker or remarks |
|
No. of installments |
Amount of each installment |
||||||||||
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
|
|
|
|
|
|
|
|
|
|
|
|
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |
![]() |