1.

(a) Name and full address of the factory / Establishment (Including Building and other Construction of Work / Motor
undertakings) Factory / Establishment Regd. Head Office
Name
Address

Telephone
Fax
E-Mail
Website

(b) Name and Residential Address of the propriter / Partner / Directors / Employer / Principal Employer / Occupier (Tic
is applicable)
Sl. No Name Designation Residential Address Tel / Mobile / E
1 2 3 4 5

( C) Registration and License Regn. No License No.

(a) Factories Act, 1948 N/A
(b) Contract Labour (R&A) Act, 1970 N/A
(c) O.S. and C.E. Act, 1956 N/A
(d) ISMW (R & CE) Act, 1979 N/A
(e) M.T.W. Act, 1961 N/A
(e) BOCW Act, 1996 N/A

(D) Building and Other Construction Workers Act, 1996

Sl. No. Category Male Female Adolescent /Adult Child Total No of Emplo
1 2 3 4 5 6 7
1 Un-Skilled
2 Semi-Skilled
3 Skilled
4 Highly Skilled
5 ITI / Diploma
6 Degree-Engg
7 Executive
8 Probationers / Trainees

No of person on Roll No of person on Roll No of days Factory / No. of No. of No. of Total amount of salary /
as on 1st January' as on 31st December' Estt / Building and days Mandays manhours including O.T. wages &
2022 2022 Other Construction Factory / worked worked
works carried on Estt. during the including
Closed year O.T.
during the
year
(b) Average number of employment during the year:-
Men Women Total

(C) No. of Employees Discharged / Dismissed / terminated / retrenched / resigned/Left or retired during the year:
Men Women Total
0

In respect of Minimum Wages and Payment of Wages etc.

6. Particulars of deduction made from salary (wages) under Minimum Wages and Payment of Wages Act

No. of Employees involved Total amount of deduction made

1. Illness
2. Damage or Loss
3. Breach of Contract
4. Others
5. Total

In respect of Factories Act / Orissa Shop & Commercial Establishment Act, 1956 /
P/O.I.E. (N & I) II. Act, 1972

7. Particulars of Earned Leave with wages / National Festival Holidays with Wages

Total No of persons No of employees Total No. of No. of employees No. of person who were paid wage
employed
1. Man eligible for Earned Employees availed/ paid wages /salary i)(Separate figure
26th January - for each day may b
ii) 19th Mar - Holi-
2. Woman iii)1st May-
iv) 1st July - Rath Yatra -
v) 15th August-
vi) 2nd October-
vii) 5th Oct - Dusshera -
viii)25th Oct - Diwali -

In respect of Payment of Bonus

8. Payment of Bonus paid during the year

Name of the Total no. of No. of employees Percentage of bonus Total amount of
Accounting Year employees eligible for bonus / exgratia declared bonus / Exgratia
1 2 3 4 5
2021-22 8.33%

Relating to Contract Labour (R & A) Act

13. (a) Contract Labour
Name and Address of the Period of Contract Nature of work / No. of Max. no of No. of
Contractor / Contractors operation in which person contract days
contract labour were employed worked
employed
Department/ Section
 Name and Address of the Nature of work / No. of No. of
Contractor / Contractors operation in which person contract days
contract labour were employed work man worked
From To employed employed
Department/ Section in any day
during the
year
(i)
(ii)
(iii)
(iv)
TOTAL

Relating to Inter State Migrant Workmen (RE & CS) Act

15. (i) No of contractors who worked in the establshment during the year with details.

Name and Address of the Period of Contract Nature of Work Maximum number No. of
Contractor of workers supplied days
From To by each contractor worked

Signature of Occupier/Employer/Manag
struction of Work / Motor Transport
Regd. Head Office

Employer / Occupier (Tick whichever

Tel / Mobile / Email

5

License No.

Total No of Employees
7

Total amount of salary / wages paid

including O.T. wages & allowances
 Total

tired during the year:

Total
0

s etc.
Wages Act

mount of deduction made

ment Act, 1956 /

rson who were paid wages for the NFH

figure
nuary - for each day may be furnished)
ar - Holi-
y-
y - Rath Yatra -
ugust-
tober-
ct - Dusshera -
Oct - Diwali -

Date of Payment
6

No. of man days worked

 No. of man days worked

ct

No. of Mandays worked

er/Employer/Manager