Govt. of India, Ministry of Labour & Employment

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 change

2(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
Sl. No.	Name of employed person	Father’s or Husband’s name	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
1	2	3	4	5	6	7	8	9	10

Part- II

Particulars of disbursement of Fines

Date of disbursement			Remarks
Date of disbursement	Amount of disbursement	Purpose for which amount disbursed	Remarks
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
Sl. No.	Name of employed person	Father’s or Husband’s name	Nature of employ-ment	Damage or loss caused and its value			Date and amount of deduction imposed	No. of installments, if any	Date on which total amount realized	Remarks
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
Sl. No.	Name of employed person	Designation	Father’s/ Husband’s name		Total attendance / Total no. of units worked	Remarks
1	2	3	4	5	6	7

Form V

(See rule 6)

Register of Wages

Name of Establishment__________________Name & address of employer___________

Location_____________________

Wage period from____________to ______ Post office _________________

Govt. of India, Ministry of Labour & Employment

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

Other allowance

Basic

O.T.

Other allowances

Govt. of India, Ministry of Labour & Employment

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.	Other deductions	Other deductions	Net amount payable	Acquittance with date	Remarks
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_____________________

Wage period from____________to ______ Post office _________________

Govt. of India, Ministry of Labour & Employment

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

Other allowance

Basic

O.T.

Other allowances

Govt. of India, Ministry of Labour & Employment

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.	Deductions from wages on account of other deductions	Total deductions	Net amount payable	Acquittance with date	Remarks
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_________________

Date from which wage rates will be or are enforced _________

Sl. No.			Rate of Wages Rs. P.	Rate of allowances, if any	Remarks
Sl. No.	Class of employees or description of work	Particulars of Wage period	Rate of Wages Rs. P.	Rate of allowances, if any	Remarks
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

_______________________________________________________________

5.Number of cases and amount realized:-
( 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
Govt. of India, Ministry of Labour & Employment

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

Govt. of India, Ministry of Labour & Employment

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