Professional Documents
Culture Documents
2/17/2018 6:11
Salary Calculation
Designed By Joshua.M
Form No. 25
(Prescribed Under Rule 103 of the Madras Factory Rules 1950 & under G.O. No. 2759 of 1959)
Date of Joining
FOR THE PERIOD ENDING DAYS
Basic + DA
Employee ID
Salary
Designation Nature of
S.No.
Name of the Worker Father s Name Work ESI Number EPF Number
Wednesday
Wednesday
Wednesday
Thursday
Thursday
Thursday
Saturday
Saturday
Saturday
Monday
Monday
Monday
Tuesday
Tuesday
Tuesday
Sunday
Sunday
Sunday
Sunday
Friday
Friday
Friday
Date Month Year
1 2 3 4 5 6 7 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22
X X
1 001 JOSHUA GOD MANAGER 12345678 5000.00 3000.00
2 002
3 003
4 004
5 005
6 006
7 007
8 008
9 009
10 010
11 011
12 012
13 013
14 014
15 015
16 016
17 017
18 018
19 019
November-2009
Dated: 2/17/2018 6:11
Other Allowance
Other Deduction
Bal Advance
FOR THE PERIOD ENDING DAYS
with wages
O.T Hours
for wages
Advance
P.T.
I.T.
Wednesday
Thursday
Saturday
Monday
Monday
Tuesday
Tuesday
Sunday
Friday
23 24 25 26 27 28 29 30 01 10 11 12 13 14 15 16 18 19 20 21 22 23 24 25
X X
4 0 0 4 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 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 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
0 0 0 0 0
0 0 0 0 0
Wages Min
Date of Joining
Minimum rate
Emp.ID
Total Wages
S.No.
Conveyance
Basic+HRA
Allowance
Allowance
Basic + DA
Designation
of wages
Medical
the Employee
Salary
Total
HRA
HRA
1 001 JOSHUA MANAGER 5000.00 3000.00 1250.00 4250.00 750.00 500.00 5500.00 400.00 167.00
Wages Min
Date of Joining
Minimum rate
Emp.ID
Total Wages
S.No.
Conveyance
Basic+HRA
Allowance
Allowance
Basic + DA
Designation
of wages
Medical
the Employee
Salary
Total
HRA
HRA
9 009 0.00 0.00 0.00 0.00 0.00 0.00 0.00
Wages Min
Date of Joining
Minimum rate
Emp.ID
Total Wages
S.No.
Conveyance
Basic+HRA
Allowance
Allowance
Basic + DA
Designation
of wages
Medical
the Employee
Salary
Total
HRA
HRA
17 017 0.00 0.00 0.00 0.00 0.00 0.00 0.00
GRAND TOTAL 5000.00 3000.00 1250.00 4250.00 750.00 500.00 5500.00 400.00 167.00
Busfare Earnings
Normal Earning
O.T. earning
Advance Loan
month
Total normal
Total Wages
Conveyance
deductions
Allowance
Allowance
Medical
Others
Wages
567.00 100.00 67.00 734.00 4.0 0.0 0.0 734.00 0.00 241.00 88.00 238.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
Busfare Earnings
Normal Earning
O.T. earning
Advance Loan
month
Total normal
Total Wages
Conveyance
deductions
Allowance
Allowance
Medical
Others
Wages
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
Busfare Earnings
Normal Earning
O.T. earning
Advance Loan
month
Total normal
Total Wages
Conveyance
deductions
Allowance
Allowance
Medical
Others
Wages
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00 0.0 0.0 0.0 0.00 0.00 0.00 0.00 0.00
567.00 100.00 67.00 734.00 734.00 0.00 0.00 241.00 88.00 238.00 0.00 0.00 0.00 0.00
FROM WAGES
EMPLOYEER
CONTRIBUTION
Advance Loan
EPF Number
ESI Number
Balance
Deduction Date & Signature
of Employees
E.E.P.F
E.E.S.I
Total
FROM WAGES
EMPLOYEER
CONTRIBUTION
Advance Loan
EPF Number
ESI Number
Balance
Deduction Date & Signature
of Employees
E.E.P.F
E.E.S.I
Total
FROM WAGES
EMPLOYEER
CONTRIBUTION
Advance Loan
EPF Number
ESI Number
Balance
Deduction Date & Signature
of Employees
E.E.P.F
E.E.S.I
Total
734.00 326.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
Net Salary: 408.00 Authorised Signatory
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
Net Salary: 0.00 Authorised Signatory
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
Net Salary: 0.00 Authorised Signatory
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
Net Salary: 0.00 Authorised Signatory
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
7th 0.00
Balance Advance Recoverable Days Worked Days Absent Account Number
EPF:
0.00 0.00
ESI:
EARNINGS DEDUCTIONS
Earned Basic 0.00 EPF 0.00
Earned HRA 0.00 ESI 0.00
Earned Conv. Allowance 0.00 P.T
Earned Medical Allowance 0.00 I.T
O.T 0.00 Employee Advance
Other Deduction
0.00 0.00
Amount In Words: for YOUR COMPANY NAME,
Err:511
(a) Name
(b) Designation
(c) Residential Address
I furnish below the details of the Employer's share of contribution in respect of the under mentioned insured persons. I hereby declare that the
return includes each and every employee, employed directly or through an immediate employer or in connection with the work of the factory /
establishment or any work connected with the administration of the factory / establishment or purchase of raw materials, sale or distribution of
finished products ect. To whom the ESI Act, 1948 applies, in the contribution period to which this return relates and that the contributions in
respect of employer's and employee's share have been correctly paid in accordance with the provisions of the Act and Regulations.
Employee's Share
Employer's Share
Total Contribution
Details of Challans:
Sl.No. Month Date of Challan Amount Name of the Bank & Branch
(i) If any I.P. is appointed for the first time and / or leaves during the contribution period indicate "A………….(date) and / or "L………… (date)"
(ii) Please indicate Insurance Nos. In ascending order.
(iii) Figures in Columns 4, 5 & 6 shall be in respect of wage periods ended during the contribution period.
(iv) Invariably strike totals of Columns 4, 5 and 6 of the Return,
(v) No overwriting shall be made. Any corrections, if made, should be signed by the employer.
(vi) Every page of this Return should bear full signature and rubber stamp of the employer.
(vii) Daily wages in Column 7 of the return shall be calculated by dividing figures in Column 5 by figures in Column 4 to two decimal places.
For *CP ending 31st March, due date is 12th May
For CP ending 30th September, due date is 11th November
I declare that
(a) All the Records and Registers have been maintained as per provisions contained in ESI Act, Rules & Regulations framed therein.
(b) During the period of return…………………No. of Declaration forms have been submitted.
(c) During the above period……………………………….No. of TICs have been received.
(d) During the above period……………………………….No. of PICs have been received.
(e) During the above period……………………………….No. of PICs have been distributed amongst the eligible Ips.
(f) During the above period……………………………….accidents have been reported to the concerned Branch Office.
(g) During the above period……………………………….No. of employees directly employed by us have been covered and a total wages of Rs.
have been paid to such employees.
(h) During the above period………………………….No. of employees directly employed by us have not been covered and a total wages of Rs.
have been paid to such employees.
(i) During the above period………………………….No. of employees employed through immediate employer have been covered and a total wages
of Rs. have been paid to such employees.
(j) During the above period………………………….No. of employees employed through immediate employer have been covered and a total wages
Page 24 of 35
of Rs. have been paid to such employees.
Form 5
(k) Following components of wages have been taken into consideration for the purpose of payment of contribution.
(l) Following components of wages have been taken into consideration for the purpose of payment of contribution.
1 3 5
2 4
The above mentioned information is based on records and any information if found incorrect will render me liable for prosecutions unders
provisions of ESI Act and action for recovery of contribution due along-with inrerest and damages as per provision of the ESI Act.
Page 25 of 35
Form-6
E. S. I ACT FORM NO. 6
REGISTER OF EMPLOYEE'S
(REGULATION No. 32)
Name and Address of the CONTRIBUTION PERIOD
Establishment
From Apr-09 To Sep-09
MONTH (Apr-08) MONTH (May-08) MONTH (Jun-08) MONTH (Jul-08) MONTH (Aug-08) MONTH (Sep-08)
contribution in the
No. of days for which
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
Total employees
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
of appointment
Insurance No.
paid/payable
which wages
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Occupation
contribution
contribution
contribution
contribution
contribution
contribution
period
S. No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.
1 12345678 JOSHUA MANAGER 4.00 400.00 238.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1754.00 31.00 26.00 2400.00 42.00 26.00 2400.00 42.00 75.00 6954.00 353.00 92.72
2 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1974.00 35.00 26.00 2700.00 48.00 26.00 2700.00 48.00 71.00 7374.00 131.00 103.86
3 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20.00 1454.00 26.00 26.00 1890.00 34.00 26.00 1890.00 34.00 72.00 5234.00 94.00 72.69
4 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1059.00 0.00 23.00 1451.00 0.00 25.00 1577.00 0.00 65.00 4087.00 0.00 62.88
5 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1152.00 0.00 25.00 1601.00 0.00 23.50 1505.00 0.00 66.50 4258.00 0.00 64.03
6 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1142.00 0.00 20.00 1269.00 0.00 14.50 937.00 0.00 52.50 3348.00 0.00 63.77
7 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1173.00 0.00 24.00 1565.00 0.00 25.00 1629.00 0.00 67.00 4367.00 0.00 65.18
8 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1272.00 0.00 22.50 1505.00 0.00 9.00 602.00 0.00 50.50 3379.00 0.00 66.91
9 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1226.00 0.00 26.00 1770.00 0.00 22.00 1498.00 0.00 66.00 4494.00 0.00 68.09
10 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1345.00 24.00 24.00 1698.00 30.00 23.00 1672.00 30.00 66.00 4715.00 84.00 71.44
11 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 921.00 0.00 15.00 952.00 0.00 7.50 476.00 0.00 37.50 2349.00 0.00 62.64
12 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1163.00 0.00 8.00 517.00 0.00 5.50 356.00 0.00 31.50 2036.00 0.00 64.63
13 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1239.00 0.00 25.00 1629.00 0.00 25.50 1662.00 0.00 69.50 4530.00 0.00 65.18
14 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1138.00 0.00 22.50 1505.00 0.00 24.00 1606.00 0.00 63.50 4249.00 0.00 66.91
15 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1128.00 0.00 23.50 1559.00 0.00 24.00 1592.00 0.00 64.50 4279.00 0.00 66.34
16 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1239.00 0.00 22.00 1435.00 0.00 10.00 652.00 0.00 51.00 3326.00 0.00 65.22
17 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1162.00 0.00 26.00 1590.00 0.00 26.00 1590.00 0.00 71.00 4342.00 0.00 61.15
18 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 923.00 0.00 23.00 1433.00 0.00 25.00 1557.00 0.00 63.00 3913.00 0.00 62.11
19 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 615.00 0.00 18.00 1108.00 0.00 19.00 1170.00 0.00 47.00 2893.00 0.00 61.55
20 0 0 0 0.00 400.00 238.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 370.00 0.00 4.00 246.00 0.00 0.00 0.00 0.00 10.00 1016.00 238.00 101.60
21 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1337.00 24.00 5.00 352.00 7.00 0.00 0.00 0.00 24.00 1689.00 31.00 70.38
22 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 888.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 888.00 0.00 63.43
23 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1870.00 33.00 26.00 2700.00 48.00 26.00 2700.00 48.00 70.00 7270.00 129.00 103.86
24 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1236.00 22.00 26.00 1890.00 34.00 26.00 1890.00 34.00 69.00 5016.00 90.00 72.70
25 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1138.00 0.00 26.00 1740.00 0.00 23.00 1540.00 0.00 66.00 4418.00 0.00 66.94
26 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1120.00 20.00 24.00 1680.00 30.00 26.00 1820.00 32.00 66.00 4620.00 82.00 70.00
27 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1046.00 0.00 23.00 1415.00 0.00 25.50 1570.00 0.00 65.50 4031.00 0.00 61.54
28 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1046.00 0.00 23.00 1415.00 0.00 21.00 1292.00 0.00 61.00 3753.00 0.00 61.52
29 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1099.00 0.00 26.00 1680.00 0.00 26.00 1680.00 0.00 69.00 4459.00 0.00 64.62
30 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1099.00 0.00 25.00 1616.00 0.00 2.00 129.00 0.00 44.00 2844.00 0.00 64.64
31 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1108.00 0.00 23.00 1499.00 0.00 0.00 0.00 0.00 40.00 2607.00 0.00 65.18
32 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1205.00 0.00 22.00 1472.00 0.00 13.50 903.00 0.00 53.50 3580.00 0.00 66.92
33 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1034.00 0.00 20.00 1293.00 0.00 25.00 1616.00 0.00 61.00 3943.00 0.00 64.64
34 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1043.00 0.00 21.00 1369.00 0.00 23.00 1499.00 0.00 60.00 3911.00 0.00 65.18
35 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1046.00 0.00 22.00 1354.00 0.00 26.00 1600.00 0.00 65.00 4000.00 0.00 61.54
36 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 969.00 0.00 4.00 259.00 0.00 0.00 0.00 0.00 19.00 1228.00 0.00 64.63
37 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1006.00 0.00 25.00 1572.00 0.00 26.00 1635.00 0.00 67.00 4213.00 0.00 62.88
38 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1006.00 0.00 25.00 1572.00 0.00 26.00 1635.00 0.00 67.00 4213.00 0.00 62.88
39 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1070.00 0.00 24.00 1606.00 0.00 23.00 1540.00 0.00 63.00 4216.00 0.00 66.92
40 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.50 1085.00 19.00 18.00 1260.00 23.00 19.00 1330.00 24.00 52.50 3675.00 66.00 70.00
41 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 873.00 0.00 26.00 1620.00 0.00 23.00 1433.00 0.00 63.00 3926.00 0.00 62.32
42 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 795.00 0.00 26.00 1590.00 0.00 21.00 1284.00 0.00 60.00 3669.00 0.00 61.15
43 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 747.00 0.00 5.00 311.00 0.00 0.00 0.00 0.00 17.00 1058.00 0.00 62.24
44 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 969.00 0.00 26.00 1680.00 0.00 25.00 1616.00 0.00 66.00 4265.00 0.00 64.62
45 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 937.00 0.00 11.00 736.00 0.00 26.00 1740.00 0.00 51.00 3413.00 0.00 66.92
46 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.50 921.00 0.00 21.50 1365.00 0.00 22.00 1396.00 0.00 58.00 3682.00 0.00 63.48
47 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 888.00 0.00 16.50 1048.00 0.00 16.00 1015.00 0.00 46.50 2951.00 0.00 63.46
48 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 870.00 0.00 26.00 1740.00 0.00 26.00 1740.00 0.00 65.00 4350.00 0.00 66.92
49 0 0 0 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 810.00 0.00 5.00 311.00 0.00 0.00 0.00 0.00 18.00 1121.00 0.00 62.28
Rs. C/o…. 800.00 476.00 0.00 0.00 0.00 0.00 53710.00 234.00 67968.00 296.00 61674.00 292.00 184152.00 1298.00 3332.70
Form-6
E. S. I ACT FORM NO. 6
REGISTER OF EMPLOYEE'S
(REGULATION No. 32)
Name and Address of the CONTRIBUTION PERIOD
Establishment
From Apr-09 To Sep-09
MONTH (Apr-08) MONTH (May-08) MONTH (Jun-08) MONTH (Jul-08) MONTH (Aug-08) MONTH (Sep-08)
contribution in the
No. of days for which
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
Total employees
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
of appointment
Insurance No.
paid/payable
which wages
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Occupation
contribution
contribution
contribution
contribution
contribution
contribution
period
S. No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.
Rs. B/f… 800.00 476.00 0.00 0.00 0.00 0.00 53710.00 234.00 67968.00 296.00 61674.00 292.00 184152.00 1298.00 3332.70
50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 978.00 0.00 25.00 1745.00 0.00 22.00 1501.00 0.00 61.00 4224.00 0.00 69.25
51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
52 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 885.00 0.00 12.50 851.00 0.00 0.00 0.00 0.00 25.50 1736.00 0.00 68.08
53 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 934.00 0.00 24.00 1496.00 0.00 26.00 1620.00 0.00 65.00 4050.00 0.00 62.31
54 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 943.00 0.00 23.00 1447.00 0.00 22.00 1384.00 0.00 60.00 3774.00 0.00 62.90
55 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 840.00 0.00 12.50 807.00 0.00 24.50 1583.00 0.00 50.00 3230.00 0.00 64.60
56 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 995.00 0.00 26.00 1725.00 0.00 25.00 1659.00 0.00 66.00 4379.00 0.00 66.35
57 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 954.00 0.00 21.00 1396.00 0.00 23.00 1565.00 0.00 58.00 3915.00 0.00 67.50
58 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 938.00 17.00 25.00 1803.00 32.00 25.00 1803.00 32.00 63.00 4544.00 81.00 72.13
59 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 945.00 0.00 26.00 1755.00 0.00 21.50 1451.00 0.00 61.50 4151.00 0.00 67.50
60 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 978.00 0.00 26.00 1695.00 0.00 26.00 1695.00 0.00 67.00 4368.00 0.00 65.19
61 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 923.00 0.00 6.00 370.00 0.00 9.50 585.00 0.00 30.50 1878.00 0.00 61.57
62 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.00 677.00 0.00 24.00 1477.00 0.00 21.50 1323.00 0.00 56.50 3477.00 0.00 61.54
63 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 1137.00 20.00 26.00 1970.00 35.00 26.00 1970.00 35.00 67.00 5077.00 90.00 75.78
64 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 747.00 0.00 18.00 1121.00 0.00 23.00 1433.00 0.00 53.00 3301.00 0.00 62.28
65 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 870.00 0.00 24.00 1606.00 0.00 24.50 1640.00 0.00 61.50 4116.00 0.00 66.93
66 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 855.00 0.00 23.00 1513.00 0.00 25.00 1644.00 0.00 61.00 4012.00 0.00 65.77
67 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 11.00 723.00 0.00 25.00 1644.00 0.00 25.00 1644.00 0.00 61.00 4011.00 0.00 65.75
68 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 747.00 0.00 24.00 1496.00 0.00 24.00 1496.00 0.00 60.00 3739.00 0.00 62.32
69 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 805.00 0.00 20.50 1270.00 0.00 14.50 898.00 0.00 48.00 2973.00 0.00 61.94
70 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 768.00 0.00 23.00 1472.00 0.00 22.00 1409.00 0.00 57.00 3649.00 0.00 64.02
71 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 870.00 0.00 23.00 1540.00 0.00 25.00 1673.00 0.00 61.00 4083.00 0.00 66.93
72 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 870.00 0.00 24.00 1606.00 0.00 24.50 1640.00 0.00 61.50 4116.00 0.00 66.93
73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.50 837.00 0.00 26.00 1740.00 0.00 25.00 1673.00 0.00 63.50 4250.00 0.00 66.93
74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 803.00 0.00 25.50 1707.00 0.00 25.00 1673.00 0.00 62.50 4183.00 0.00 66.93
75 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 805.00 0.00 21.00 1300.00 0.00 18.00 1115.00 0.00 52.00 3220.00 0.00 61.92
76 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 848.00 0.00 25.00 1629.00 0.00 24.00 1565.00 0.00 62.00 4042.00 0.00 65.19
77 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 818.00 0.00 25.00 1572.00 0.00 24.50 1541.00 0.00 62.50 3931.00 0.00 62.90
78 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 837.00 0.00 25.00 1745.00 0.00 24.00 1676.00 0.00 61.00 4258.00 0.00 69.80
79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 863.00 0.00 24.00 1592.00 0.00 24.50 1625.00 0.00 61.50 4080.00 0.00 66.34
80 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 865.00 16.00 26.00 1875.00 33.00 24.50 1786.00 32.00 62.50 4526.00 81.00 72.42
81 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 870.00 0.00 25.00 1673.00 0.00 25.00 1673.00 0.00 63.00 4216.00 0.00 66.92
82 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 803.00 0.00 24.50 1640.00 0.00 19.50 1305.00 0.00 56.00 3748.00 0.00 66.93
83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 597.00 0.00 25.00 1659.00 0.00 21.50 1426.00 0.00 55.50 3682.00 0.00 66.34
84 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 800.00 0.00 25.00 1538.00 0.00 22.50 1385.00 0.00 60.50 3723.00 0.00 61.54
85 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 768.00 0.00 22.00 1409.00 0.00 26.00 1665.00 0.00 60.00 3842.00 0.00 64.03
86 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 652.00 0.00 23.50 1532.00 0.00 24.00 1565.00 0.00 57.50 3749.00 0.00 65.20
87 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 738.00 0.00 22.00 1354.00 0.00 22.00 1354.00 0.00 56.00 3446.00 0.00 61.54
88 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 738.00 0.00 20.00 1230.00 0.00 23.00 1415.00 0.00 55.00 3383.00 0.00 61.51
89 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 664.00 0.00 24.00 1592.00 0.00 22.50 1493.00 0.00 56.50 3749.00 0.00 66.35
90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 704.00 13.00 20.00 1408.00 25.00 19.00 1337.00 24.00 49.00 3449.00 62.00 70.39
91 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 433.00 8.00 24.00 1731.00 31.00 25.00 1823.00 32.00 55.00 3987.00 71.00 72.49
92 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 549.00 0.00 20.00 1373.00 0.00 19.00 1305.00 0.00 47.00 3227.00 0.00 68.66
93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
94 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 489.00 0.00 19.00 1162.00 0.00 0.00 0.00 0.00 27.00 1651.00 0.00 61.15
95 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 615.00 0.00 22.00 1354.00 0.00 16.50 1015.00 0.00 48.50 2984.00 0.00 61.53
96 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 615.00 0.00 26.00 1600.00 0.00 22.00 1354.00 0.00 58.00 3569.00 0.00 61.53
97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 1350.00 24.00 26.00 2700.00 48.00 26.00 2700.00 48.00 65.00 6750.00 120.00 103.85
98 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 654.00 12.00 26.00 1890.00 34.00 26.00 1890.00 34.00 61.00 4434.00 80.00 72.69
Rs. C/o…. 800.00 476.00 0.00 0.00 0.00 0.00 91807.00 344.00 139778.00 534.00 130649.00 529.00 363034.00 1883.00 6465.32
Form-6
E. S. I ACT FORM NO. 6
REGISTER OF EMPLOYEE'S
(REGULATION No. 32)
Name and Address of the CONTRIBUTION PERIOD
Establishment
From Apr-09 To Sep-09
MONTH (Apr-08) MONTH (May-08) MONTH (Jun-08) MONTH (Jul-08) MONTH (Aug-08) MONTH (Sep-08)
contribution in the
No. of days for which
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
Total employees
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
of appointment
Insurance No.
paid/payable
which wages
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Occupation
contribution
contribution
contribution
contribution
contribution
contribution
period
S. No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.
Rs. B/f… 800.00 476.00 0.00 0.00 0.00 0.00 91807.00 344.00 139778.00 534.00 130649.00 529.00 363034.00 1883.00 6465.32
99 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 256.00 0.00 19.50 1249.00 0.00 25.00 1601.00 0.00 48.50 3106.00 0.00 64.04
100 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 561.00 0.00 25.00 1557.00 0.00 25.50 1589.00 0.00 59.50 3707.00 0.00 62.30
101 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 522.00 0.00 22.00 1435.00 0.00 9.00 587.00 0.00 39.00 2544.00 0.00 65.23
102 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 561.00 0.00 25.00 1557.00 0.00 26.00 1620.00 0.00 60.00 3738.00 0.00 62.30
103 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 587.00 0.00 25.00 1629.00 0.00 26.00 1695.00 0.00 60.00 3911.00 0.00 65.18
104 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 628.00 0.00 19.50 1362.00 0.00 0.00 0.00 0.00 28.50 1990.00 0.00 69.82
105 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 644.00 12.00 22.00 1574.00 28.00 21.00 1502.00 27.00 52.00 3720.00 67.00 71.54
106 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 572.00 11.00 22.00 1574.00 28.00 0.00 0.00 0.00 30.00 2146.00 39.00 71.53
107 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 613.00 0.00 24.00 1634.00 0.00 25.00 1701.00 0.00 58.00 3948.00 0.00 68.07
108 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 599.00 0.00 26.00 1730.00 0.00 25.00 1663.00 0.00 60.00 3992.00 0.00 66.53
109 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 587.00 0.00 26.00 1695.00 0.00 26.00 1695.00 0.00 61.00 3977.00 0.00 65.20
110 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.00 484.00 0.00 23.00 1592.00 0.00 20.00 1384.00 0.00 50.00 3460.00 0.00 69.20
111 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 587.00 0.00 23.00 1499.00 0.00 26.00 1695.00 0.00 58.00 3781.00 0.00 65.19
112 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 581.00 0.00 12.00 776.00 0.00 25.00 1616.00 0.00 46.00 2973.00 0.00 64.63
113 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 623.00 0.00 26.00 1800.00 0.00 24.50 1697.00 0.00 59.50 4120.00 0.00 69.24
114 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 551.00 0.00 24.00 1468.00 0.00 18.00 1101.00 0.00 51.00 3120.00 0.00 61.18
115 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.00 554.00 0.00 23.00 1415.00 0.00 21.00 1292.00 0.00 53.00 3261.00 0.00 61.53
116 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.50 467.00 9.00 26.00 1865.00 33.00 26.00 1890.00 34.00 58.50 4222.00 76.00 72.17
117 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 553.00 0.00 12.50 866.00 0.00 21.00 1453.00 0.00 41.50 2872.00 0.00 69.20
118 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 499.00 0.00 19.50 1215.00 0.00 20.50 1278.00 0.00 48.00 2992.00 0.00 62.33
119 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 7.00 453.00 0.00 14.00 904.00 0.00 23.00 1486.00 0.00 44.00 2843.00 0.00 64.61
120 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 492.00 0.00 16.00 985.00 0.00 11.00 677.00 0.00 35.00 2154.00 0.00 61.54
121 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 492.00 0.00 21.00 1292.00 0.00 0.00 0.00 0.00 29.00 1784.00 0.00 61.52
122 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 492.00 0.00 16.00 985.00 0.00 9.00 554.00 0.00 33.00 2031.00 0.00 61.55
123 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 8.00 492.00 0.00 8.50 523.00 0.00 0.00 0.00 0.00 16.50 1015.00 0.00 61.52
124 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 425.00 8.00 25.00 1770.00 31.00 25.00 1770.00 31.00 56.00 3965.00 70.00 70.80
125 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.00 352.00 7.00 21.00 1478.00 26.00 20.50 1443.00 26.00 46.50 3273.00 59.00 70.39
126 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 370.00 0.00 17.00 1046.00 0.00 0.00 0.00 0.00 23.00 1416.00 0.00 61.57
127 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.00 391.00 0.00 25.50 1662.00 0.00 8.00 522.00 0.00 39.50 2575.00 0.00 65.19
128 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.00 308.00 0.00 19.00 1170.00 0.00 19.00 1170.00 0.00 43.00 2648.00 0.00 61.58
129 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 288.00 6.00 22.00 1587.00 28.00 26.00 1875.00 33.00 52.00 3750.00 67.00 72.12
130 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 246.00 0.00 26.00 1600.00 0.00 20.00 1230.00 0.00 50.00 3076.00 0.00 61.52
131 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.00 246.00 0.00 20.00 1230.00 0.00 22.50 1385.00 0.00 46.50 2861.00 0.00 61.53
132 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.00 144.00 3.00 19.00 1371.00 24.00 0.00 0.00 0.00 21.00 1515.00 27.00 72.14
133 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1.00 62.00 0.00 25.00 1538.00 0.00 26.00 1600.00 0.00 52.00 3200.00 0.00 61.54
134 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26.00 3050.00 54.00 25.50 3050.00 54.00 51.50 6100.00 108.00 118.45
135 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 26.00 1610.00 0.00 25.00 1548.00 0.00 51.00 3158.00 0.00 61.92
136 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1088.00 0.00 22.00 1409.00 0.00 39.00 2497.00 0.00 64.03
137 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.00 1472.00 0.00 24.50 1640.00 0.00 46.50 3112.00 0.00 66.92
138 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25.00 1701.00 0.00 20.00 1362.00 0.00 45.00 3063.00 0.00 68.07
139 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 25.00 1731.00 0.00 26.00 1800.00 0.00 51.00 3531.00 0.00 69.24
140 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 24.50 1710.00 0.00 26.00 1815.00 0.00 50.50 3525.00 0.00 69.80
141 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.50 1480.00 0.00 7.00 460.00 0.00 29.50 1940.00 0.00 65.76
142 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23.00 1513.00 0.00 21.50 1414.00 0.00 44.50 2927.00 0.00 65.78
143 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23.00 1513.00 0.00 21.00 1381.00 0.00 44.00 2894.00 0.00 65.77
144 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.00 1472.00 0.00 9.00 602.00 0.00 31.00 2074.00 0.00 66.90
145 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.50 1521.00 27.00 5.00 354.00 7.00 26.50 1875.00 34.00 70.75
146 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 23.00 2388.00 42.00 23.00 2388.00 42.00 46.00 4776.00 84.00 103.83
147 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 747.00 0.00 23.00 1433.00 0.00 35.00 2180.00 0.00 62.29
Rs. C/o…. 800.00 476.00 0.00 0.00 0.00 0.00 108089.00 400.00 211407.00 855.00 192076.00 783.00 512372.00 2514.00 9780.36
Form-6
E. S. I ACT FORM NO. 6
REGISTER OF EMPLOYEE'S
(REGULATION No. 32)
Name and Address of the CONTRIBUTION PERIOD
Establishment
From Apr-09 To Sep-09
MONTH (Apr-08) MONTH (May-08) MONTH (Jun-08) MONTH (Jul-08) MONTH (Aug-08) MONTH (Sep-08)
contribution in the
No. of days for which
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
Total employees
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
of appointment
Insurance No.
paid/payable
which wages
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Occupation
contribution
contribution
contribution
contribution
contribution
contribution
period
S. No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.
Rs. B/f… 800.00 476.00 0.00 0.00 0.00 0.00 108089.00 400.00 211407.00 855.00 192076.00 783.00 512372.00 2514.00 9780.36
148 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 21.00 1345.00 0.00 20.50 1312.00 0.00 41.50 2657.00 0.00 64.02
149 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.00 1549.00 28.00 0.00 0.00 0.00 22.00 1549.00 28.00 70.41
150 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.00 1371.00 0.00 0.00 0.00 0.00 22.00 1371.00 0.00 62.32
151 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20.00 1281.00 0.00 21.50 1377.00 0.00 41.50 2658.00 0.00 64.05
152 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 22.00 1536.00 0.00 22.00 1536.00 0.00 44.00 3072.00 0.00 69.82
153 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1205.00 0.00 23.00 1540.00 0.00 41.00 2745.00 0.00 66.95
154 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1128.00 0.00 24.50 1625.00 0.00 41.50 2753.00 0.00 66.34
155 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1064.00 0.00 7.50 499.00 0.00 23.50 1563.00 0.00 66.51
156 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.50 1037.00 0.00 21.50 1439.00 0.00 37.00 2476.00 0.00 66.92
157 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 1010.00 18.00 24.50 1767.00 31.00 38.50 2777.00 49.00 72.13
158 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1364.00 24.00 26.00 1970.00 35.00 44.00 3334.00 59.00 75.77
159 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1121.00 0.00 24.00 1496.00 0.00 42.00 2617.00 0.00 62.31
160 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1139.00 0.00 24.00 1519.00 0.00 42.00 2658.00 0.00 63.29
161 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 961.00 0.00 23.00 1472.00 0.00 38.00 2433.00 0.00 64.03
162 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1152.00 0.00 24.00 1537.00 0.00 42.00 2689.00 0.00 64.02
163 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 904.00 0.00 19.00 1227.00 0.00 33.00 2131.00 0.00 64.58
164 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1173.00 0.00 26.00 1695.00 0.00 44.00 2868.00 0.00 65.18
165 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 978.00 0.00 24.00 1565.00 0.00 39.00 2543.00 0.00 65.21
166 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1184.00 0.00 18.00 1184.00 0.00 36.00 2368.00 0.00 65.78
167 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1194.00 0.00 21.50 1426.00 0.00 39.50 2620.00 0.00 66.33
168 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 1004.00 0.00 23.50 1573.00 0.00 38.50 2577.00 0.00 66.94
169 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1157.00 0.00 20.00 1362.00 0.00 37.00 2519.00 0.00 68.08
170 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1226.00 0.00 23.50 1600.00 0.00 41.50 2826.00 0.00 68.10
171 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1196.00 21.00 21.50 1513.00 27.00 38.50 2709.00 48.00 70.36
172 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1154.00 21.00 19.00 1371.00 24.00 35.00 2525.00 45.00 72.14
173 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1298.00 23.00 24.00 1731.00 31.00 42.00 3029.00 54.00 72.12
174 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1154.00 21.00 24.00 1731.00 31.00 40.00 2885.00 52.00 72.13
175 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1177.00 0.00 26.00 1800.00 0.00 43.00 2977.00 0.00 69.23
176 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 897.00 0.00 24.00 1537.00 0.00 38.00 2434.00 0.00 64.05
177 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 782.00 0.00 22.00 1435.00 0.00 34.00 2217.00 0.00 65.21
178 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.50 822.00 0.00 19.00 1250.00 0.00 31.50 2072.00 0.00 65.78
179 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.00 928.00 0.00 9.00 597.00 0.00 23.00 1525.00 0.00 66.30
180 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 16.00 1070.00 0.00 22.50 1505.00 0.00 38.50 2575.00 0.00 66.88
181 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 747.00 0.00 14.00 873.00 0.00 26.00 1620.00 0.00 62.31
182 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 15.00 964.00 0.00 23.00 1477.00 0.00 38.00 2441.00 0.00 64.24
183 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 870.00 0.00 22.00 1472.00 0.00 35.00 2342.00 0.00 66.91
184 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 652.00 0.00 25.00 1629.00 0.00 35.00 2281.00 0.00 65.17
185 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 721.00 13.00 19.50 1406.00 25.00 29.50 2127.00 38.00 72.10
186 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 831.00 0.00 26.00 1800.00 0.00 38.00 2631.00 0.00 69.24
187 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.00 831.00 0.00 25.00 1731.00 0.00 37.00 2562.00 0.00 69.24
188 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 10.00 1174.00 21.00 26.00 3050.00 54.00 36.00 4224.00 75.00 117.33
189 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1141.00 0.00 17.00 1141.00 0.00 67.12
190 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1187.00 0.00 18.00 1187.00 0.00 65.94
191 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1254.00 0.00 19.00 1254.00 0.00 66.00
192 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1187.00 0.00 18.00 1187.00 0.00 65.94
193 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1187.00 0.00 18.00 1187.00 0.00 65.94
194 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1187.00 0.00 18.00 1187.00 0.00 65.94
195 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1254.00 0.00 19.00 1254.00 0.00 66.00
196 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1187.00 0.00 18.00 1187.00 0.00 65.94
Rs. C/o…. 800.00 476.00 0.00 0.00 0.00 0.00 108089.00 400.00 255758.00 1045.00 260289.00 1041.00 624936.00 2962.00 13109.02
Form-6
E. S. I ACT FORM NO. 6
REGISTER OF EMPLOYEE'S
(REGULATION No. 32)
Name and Address of the CONTRIBUTION PERIOD
Establishment
From Apr-09 To Sep-09
MONTH (Apr-08) MONTH (May-08) MONTH (Jun-08) MONTH (Jul-08) MONTH (Aug-08) MONTH (Sep-08)
contribution in the
No. of days for which
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
wages paid/payable
Total employees
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
Employees share of
of appointment
Insurance No.
paid/payable
which wages
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Total amount of
Occupation
contribution
contribution
contribution
contribution
contribution
contribution
period
S. No.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs. Rs.
Rs. B/f… 800.00 476.00 0.00 0.00 0.00 0.00 108089.00 400.00 255758.00 1045.00 260289.00 1041.00 624936.00 2962.00 13109.02
197 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 17.00 1121.00 0.00 17.00 1121.00 0.00 65.94
198 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 18.00 1187.00 0.00 18.00 1187.00 0.00 65.94
199 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.00 858.00 0.00 13.00 858.00 0.00 66.00
200 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 19.00 1754.00 31.00 19.00 1754.00 31.00 92.32
201 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
202 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
203 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
204 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
205
GRAND TOTAL Rs. 800.00 476.00 0.00 0.00 0.00 0.00 108089.00 400.00 255758.00 1045.00 265209.00 1072.00 629856.00 2993.00 13399.22
Form 12-A
FORM 12-A (Revised)
EMPLOYEES PROVIDENT FUND AND MISC. PROVISIONS ACT, 1952
EMPLOYEES PENSION SCHEME (PARAGRAPH 20 (4)]
Name and Address of the Estbalishment (To be filled by the EPFO)
M/s
Total