Name of Contractor :

SN

MONTH

MALE
Supervisor
FEMALE
1

Jan-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Feb-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Mar-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Apr-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

No of
Contract
Labour

CATEGORIES

May-11
MALE
Workmen

LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl

May-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Jun-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Jul-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Aug-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

Sep-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

10

Oct-11
MALE
Workmen
FEMALE
MALE
Supervisor

11

Nov-11

NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL

Supervisor
FEMALE
11

Nov-11
MALE
Workmen
FEMALE
MALE
Supervisor
FEMALE

12

Dec-11
MALE
Workmen
FEMALE

LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL
LOCAl
NON-LOCAL

Provident Fund Details

Total Mandays

Actual Paid
Gross Wages

No of
Persons

PF Wages

PF-Amount
(Remmited)

Amount of
Proff. Tax
Deducted

Leave-Payment
Rate of
Payment as
%-age to
Basic

Amount of
Paid Leave

Bonus
Rate of
Bonus Paid

Bonus Amt
paid

Overtime

Rate of OT

Wages Paid
during the
month

Manpower Details
Opening
Strength

New Joining

Left

Closing
Strength

FORM XXIX
[See rule 58]

ANNUAL RETURN OF EMPLOYER TO BE SENT TO THE REGISTERING O

1

Full name and full address of the establishment of the building

and other construction work. (Place,post office,district )

Name and permanent address of the establishment

Name and address of the employer

Nature of building and other construction work carried on.

Full name of the manager or person responsible for supervisior

and control of the establishment

Number of building workers ordinarily employed.

Total number of days during the year on which building workers

were employed.

Total number of days worked by buildig workers during the

year.

Maximum number of building workers employed on any day

during the year.

10

The number of accident that took place during the year as

under :

(a)

The total number of accidents.

(b)

The number of accidents resulting in disablment of building

workers for less than 48 hours,the number of building workers
involved and the number of man days lost

(c)

The number of accident resulting in disablement of building

workers beyond 48 hours, but not resulting in any permanent
pertial or permanent total disablement, the number of building
workers involved and the mumber of man-days lost on account
of such accidents.

(d)

The number of accidents resulting in permanent partial or total

disablement of man-days lost account of such accidents.

(e)

The number of accidents resulting in deaths of building workers

and the number of resultant deaths.

Place: Hazira
Date :

FORM XXIX
[See rule 58]

TURN OF EMPLOYER TO BE SENT TO THE REGISTERING OFFICER

Year Ending 31 st December 2011

Signature of the Employer