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COMBINED MUSTER ROLL CUM REGISTER OF WAGES

FORM T

[See Rule 24(9-b) of Karnataka Shops & Commercial Establishment Rules, 1963 in lieu of]
1
Form I and II of Rule 22(4); Form IV of Rule 28(2); Forms V & VII of Rule 29(1) & (5) of the K
2
Form I of Rule 3(1) of the Karnataka Payment of Wages (Karnataka) Rules,1963
3
Form XIII of Rule 75 and Forms XVI, XVII, XX, XXI, XXII & XXIII of Rule 78(1)(a)(i)(ii) & (iii) o
4
Form XIII of Rule 43 and Forms XVII, XVIII, XIX, XX, XXI, XXII of Rule 46(2)(a), & (d) of Int

SL No. [1]

Name of the Employee[2]

Emp No

Father/Husband Name

1 Geetha T A
2 Vishwanath S

779303 Amasegowdae
779307 Siddagangaiah T

WAGES

Male /
Female [3]

FEMALE
MALE

Trainee-K
Trainee-K

Designation/ Department
[4]

es, 1963 in lieu of]


VII of Rule 29(1) & (5) of the Karnataka Minimum Wages (Karnataka) Rules, 1958
ataka) Rules,1963
III of Rule 78(1)(a)(i)(ii) & (iii) of the Contract Labour (Regulation & Abolition) (Karnataka) Rules, 1974
of Rule 46(2)(a), & (d) of Inter- State Migrant Workmen (Regulation of Employment and Condition of Service) (Karn

Date of Joining
[5]

PF No. [7]

2-Nov-14
31-Oct-14

BG/BNG/0035224/000/0637492
BG/BNG/0035224/000/0637331

ka) Rules, 1974


and Condition of Service) (Karnataka) Rules, 1981

Attendance (Plea

Esic 7(a)

Wage fixed
including
VDA [8]

10

10

11

12

13

14

15

16

17

18

19

20

21

5038301252
5038301236

7028 P
7028 P

P
P

W/O P
P
P
W/O P

P
P

P
P

P
P

P
P

W/O
P

Attendance (Please mention the date of suspension of employee, if any [9]

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

P
P
W/O P

P
P

P
P

P
P

W/O P
P
P
W/O P

P
P

P
P

P
P

W/O P
P
P
W/O P

P
P

P
P

30

31

37

38

39

40

41

42

P
P

P
P

P
P

P
P

P
P

43

44

31
31

0
0

Conveyance [15]

29

HRA [14]

28

EARNED

Basic+DA [12]

27

Total OT hour worked [11]

26

No. of payable days [10]

NAME AND ADDRESS OF THE ESTABLISHM

45

46

47

6736
6736

0
0

0
0

F THE ESTABLISHMENT: TeamLease Services Pvt. Ltd.,6th Floor, BMTC Commercial Complex, 80ft Road, Kor

MONTH / YEAR: Mar 15


Medical Allowance [16]

Att / Bonus [17]

Special bonus [18]

OT [19]

NFH [20]

Maternity Benefit [21]

Others [22]

S. Allowance,if any [23]

Total [24]

ESI [25]

EARNED WAGES AND OTHER ALLOWANCES

48

49

50

51

52

53

54

55

56

57

0
0

292
292

0
0

0
0

0
0

0
0

0
0

0
0

7028
7028

123
123

NAME AND ADDRESS OF THE PRINCIPAL EMPLOYER:

omplex, 80ft Road, Koramangala, Bangalore-560095

BATA SHOE STORE #2 DEFENCE COLONY HESARAGHATTA


ROAD BANGALORE KARNATAKA-560078

R: Mar 15

PF [26]

VPF

PT [27]

TDS [28]

Society [29]

Insurance [30]/LWF

Sal. Advance [31]

Fines [32]

Damage / Loss [33]

Others [34]

DEDUCTIONS

58

59

60

61

62

63

64

65

66

67

808
808

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

HE PRINCIPAL EMPLOYER:

SI. No.

Total [35]

ENCE COLONY HESARAGHATTA MAIN


LORE KARNATAKA-560078

Net Payable
[36]

Mode of Payment
Cash / Cheque No.
[37]

Employee
Signature / Thumb
Impression [38]

68

69

70

71

931
931

6097 Cheque
6097 Cheque

COMBINED MUSTER ROLL CUM REGISTER OF WAGES

FORM T

[See Rule 24(9-b) of Karnataka Shops & Commercial Establishment Rules, 1963 in lieu of]
1 Form I and II of Rule 22(4); Form IV of Rule 28(2); Forms V & VII of Rule 29(1) & (5) of the Karnata
2 Form I of Rule 3(1) of the Karnataka Payment of Wages (Karnataka) Rules,1963
3 Form XIII of Rule 75 and Forms XVI, XVII, XX, XXI, XXII & XXIII of Rule 78(1)(a)(i)(ii) & (iii) of the C
4 Form XIII of Rule 43 and Forms XVII, XVIII, XIX, XX, XXI, XXII of Rule 46(2)(a), & (d) of Inter- Sta

SL No.
[1]

Name of the Employee[2]

Emp No

Father/Husband Name

Male /
Female [3]

1 Geetha T A
2 Vishwanath S
Total

779303 Amasegowdae
779307 Siddagangaiah T

FEMALE
MALE

AGES

Trainee-K
Trainee-K

Designation/ Department
[4]

963 in lieu of]


9(1) & (5) of the Karnataka Minimum Wages (Karnataka) Rules, 1958
1963
8(1)(a)(i)(ii) & (iii) of the Contract Labour (Regulation & Abolition) (Karnataka) Rules, 1974
2)(a), & (d) of Inter- State Migrant Workmen (Regulation of Employment and Condition of Service) (Karnataka) Rule

Date of Joining
[5]

PF No. [7]

2-Nov-14 BG/BNG/0035224/000/0
31-Oct-14 BG/BNG/0035224/000/0

Esic 7(a)

10

5038301252
5038301236

Service) (Karnataka) Rules, 1981

Attendance (Please mention the

Wage fixed
including
VDA [8]

10

11

11

12

13

14

15

16

17

18

19

20

21

22

P
W/O

W/O
P

P
W/O

W/O
P

7028 P
7028 P

P
P

P
P

P
P

P
P

P
P

P
P

tendance (Please mention the date of suspension of employee, if any [9]

P
P

12

13

14

15

16

17

18

19

20

21

22

23

24

23

24

25

26

27

28

29

30

31

32

33

34

35

P
W/O

W/O
P

P
W/O

W/O
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

37

38

39

P
P

P
P

P
P

40

41

28
28
56

0
0
0

Medical Allowance [16]

36

Conveyance [15]

28

HRA [14]

27

EARNED WAGES A

Basic+DA [12]

26

Total OT hour worked [11]

25

No. of payable days [10]

NAME AND ADDRESS OF THE ESTABLISHMENT: Te

42

43

44

45

6736
6736

0
0
0

0
0
0

0
0
0

STABLISHMENT: TeamLease Services Pvt. Ltd.,6th Floor, BMTC Commercial Complex, 80ft Road, Koramanga

MONTH / YEAR: Feb 15

Att / Bonus [17]

Special bonus [18]

OT [19]

NFH [20]

Maternity Benefit [21]

Others [22]

S. Allowance,if any [23]

Total [24]

ESI [25]

PF [26]

EARNED WAGES AND OTHER ALLOWANCES

46

47

48

49

50

51

52

53

54

55

292
292
584

0
0
0

0
0
0

0
0
0

0
0
0

811
811
1622

0
0
0

7839
7839
15678

138
138
276

808
808
1616

NAME AND ADDRESS OF THE PRINCIPAL EMPLOYER:

ft Road, Koramangala, Bangalore-560095

BATA SHOE STORE #2 DEFENCE COLONY HESARAGHATTA MAIN


ROAD BANGALORE KARNATAKA-560078

VPF

PT [27]

TDS [28]

Society [29]

Insurance [30]/LWF

Sal. Advance [31]

Fines [32]

Damage / Loss [33]

Others [34]

Total [35]

DEDUCTIONS

56

57

58

59

60

61

62

63

64

65

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

0
0
0

946
946
1892

AL EMPLOYER:

SI. No.

Y HESARAGHATTA MAIN
TAKA-560078

Net Payable
[36]

Mode of Payment
Cash / Cheque No.
[37]

Employee
Signature / Thumb
Impression [38]

66

67

68

6893 Cheque
6893 Cheque
13786

COMBINED MUSTER ROLL CUM REGISTER OF WAGES

FORM T

[See Rule 24(9-b) of Karnataka Shops & Commercial Establishment Rules, 1963 in lieu of]
1 Form I and II of Rule 22(4); Form IV of Rule 28(2); Forms V & VII of Rule 29(1) & (5) of the Karnata
2 Form I of Rule 3(1) of the Karnataka Payment of Wages (Karnataka) Rules,1963
3 Form XIII of Rule 75 and Forms XVI, XVII, XX, XXI, XXII & XXIII of Rule 78(1)(a)(i)(ii) & (iii) of the C
4 Form XIII of Rule 43 and Forms XVII, XVIII, XIX, XX, XXI, XXII of Rule 46(2)(a), & (d) of Inter- Sta

SL No.
[1]

Name of the Employee[2]

Emp No

Father/Husband Name

Male /
Female [3]

1 Geetha T A
2 Vishwanath S

779303 Amasegowdae
779307 Siddagangaiah T

FEMALE
MALE

AGES

Trainee-K
Trainee-K

Designation/ Department
[4]

963 in lieu of]


9(1) & (5) of the Karnataka Minimum Wages (Karnataka) Rules, 1958
1963
8(1)(a)(i)(ii) & (iii) of the Contract Labour (Regulation & Abolition) (Karnataka) Rules, 1974
2)(a), & (d) of Inter- State Migrant Workmen (Regulation of Employment and Condition of Service) (Karnataka) Rule

Date of Joining
[5]

PF No. [7]

2-Nov-14 BG/BNG/0035224/000/0637492
31-Oct-14 BG/BNG/0035224/000/0637331

Esic 7(a)

10

5038301252
5038301236

Service) (Karnataka) Rules, 1981

Attendance (Please mention t

Wage fixed
including
VDA [8]

10

11

12

11

12

13

14

15

16

17

18

19

20

21

22

23

P
W/O

W/O
P

7028 P
7028 P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

Attendance (Please mention the date of suspension of employee, if any [9]

13

14

15

16

17

18

19

20

21

22

23

24

25

26

24

25

26

27

28

29

30

31

32

33

34

35

36

37

P
W/O

W/O
P

P
W/O

W/O
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

P
P

31

38

39

40

41

42

P
W/O

W/O
P

P
P

P
P

P
P

43

44

31
31

0
0

Conveyance [15]

30

HRA [14]

29

EARNED WAG

Basic+DA [12]

28

Total OT hour worked [11]

27

No. of payable days [10]

NAME AND ADDRESS OF THE ESTABLISHMENT

45

46

47

6736
6736

0
0

0
0

F THE ESTABLISHMENT: TeamLease Services Pvt. Ltd.,6th Floor, BMTC Commercial Complex, 80ft Road, Kor

MONTH / YEAR: Jan-15


Medical Allowance [16]

Att / Bonus [17]

Special bonus [18]

OT [19]

NFH [20]

Maternity Benefit [21]

Others [22]

S. Allowance,if any [23]

Total [24]

ESI [25]

EARNED WAGES AND OTHER ALLOWANCES

48

49

50

51

52

53

54

55

56

57

0
0

292
292

0
0

0
0

0
0

0
0

0
0

0
0

7028
7028

123
123

NAME AND ADDRESS OF THE PRINCIPAL EMPLOYER:

omplex, 80ft Road, Koramangala, Bangalore-560095

BATA SHOE STORE #2 DEFENCE COLONY HESARAGHATTA


ROAD BANGALORE KARNATAKA-560078

R: Jan-15

PF [26]

VPF

PT [27]

TDS [28]

Society [29]

Insurance [30]/LWF

Sal. Advance [31]

Fines [32]

Damage / Loss [33]

Others [34]

DEDUCTIONS

58

59

60

61

62

63

64

65

66

67

808
808

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

HE PRINCIPAL EMPLOYER:

SI. No.

Total [35]

ENCE COLONY HESARAGHATTA MAIN


LORE KARNATAKA-560078

Net Payable
[36]

Mode of Payment
Cash / Cheque No.
[37]

Employee
Signature / Thumb
Impression [38]

68

69

70

71

931
931

6097 Cheque
6097 Cheque