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7/23/2019 AR Under Factory Act 1948
http://slidepdf.com/reader/full/ar-under-factory-act-1948 1/19
FORM ‘A’
(See sub rule (1) of Rule 3)
1. Name and address if the establishment M/s
2. Name and designation of the employer
3. Number of person employed
4. Maimum number of person!s employed on any Nos.
"ay during the pre#eding t$el%e months $ith date
&. Numbers of employees #o%ered by the '#t
. Nature of ndustry
*. +hether seasonal
,. "ate of opening
-. "etails of ead offi#e / ran#hes0
a) Name and address of the ead offi#e Number of employees
's abo%e
b) Name and address of other bran#hes in ndia01. N
2.3.
%erify that the information furnished abo%e is true to the best of my no$le4dge and belief.
la#e0 For
"ate0 Manager
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NOTICE
NAME AND DESIGNATION OF THE AUTHORISED PERSON UNDER SECTION
4(1) OF THE PAYMENT OF GRATUITY RULES 1!"# TO RECEI$E NOTICES
UNDER THE ACT % RULES
1. N'M 56 7 '875RS" RS5N 0 MR.
2. "S9N'75N 56 7 '875RS"0
nds0"ated
Noti#e oard
7he abour 5ffi#er:
7he abour nspe#tor:
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FACTORIES ACT 1!4&
6orm 34 (Re%ised);res#ribed under Rule 12(a)<
ANNUAL RETURN
6or the year ending 31st "e#ember ==========
1. Registration number of 6a#tory 02. Name of 6a#tory 0 M/s3. Name of 5##upier 0 Mr.
4. Name of the Manager 0 Mr.
&. "istri#t 0. 6ull ostage 'ddress of 6a#tory 0
*. Nature of ndustry 0
N8MR 56 +5R>R 'N" 'R7?8'RS 56 M5@MN7
,. No. of days $ored in the year 0
-. No. of Man "ays $ored during thea) Men 0
b) +omen 0
#) ?hildren 0
1A. '%erage number of $orers employed 0
(See eplanatory note)
a) 'dults (i) Men
(ii) +omen
b) 'doles#ent (i) Male(ii) 6emale
#) ?hildren (i) Male
(ii) 6emale
11. 7otal No. of Man hours $ored in#luding o%er time 0
a) Men 0 b) +omen 0
#) ?hildren 0
12. '%erage number of hours $ored per $ee 0(See eplanatory note)
a) Men 0 b) +omen 0
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13. (a) "oes the fa#tory #arry out pro#ess or operations
"e#lared as dangerous under se#tion ,* (see rule 11)
(b) if so: gi%e the follo$ing information
Name of the dangerous pro#ess of operations '%erage No. of persons employed daily in ea#h of?arried on the pro#esses or operations gi%en in #ol 1
1 2
(i)
(ii)(iii)
LEA$E 'ITH 'AGES
14. 7otal number of $orers employed during the year0a) Men
b) +omen
#) ?hildren
1&. Number of $orers $ho $ere entitled to annual
ea%e $ith $ages during the year a) Men
b) +omen
#) ?hildren
1. Number of $orers $ho $ere granted lea%e during the year
a) Men
b) +omen#) ?hildren
1*. a) Number of $orers $ho $ere dis#harged: or "ismissed from the ser%i#es: or Buit employment:
5r $ere superannuated: or $ho died $hile
Ser%i#e during the year.
b) Number of su#h $orers in respe#t of $hom
$ages in lieu of lea%e $ere paid.
SAFETY OFFICERS
1,. a) Number of Safety 5ffi#ers reBuired to be'ppointed as per notifi#ation under
Se#tion 4AC
b) Number of Safety 5ffi#ers appointed
AMYLANCE ROOM
1-. s there an ambulan#e room pro%ided in the6a#tory as reBuired under Se#tion 4&D
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CANTEEN
2A. a) s there a #anteen pro%ided in the fa#tory
reBuired under se#tion 4D
b) s the #anteen pro%ided managedD
i) "epartmentally: or ii) 7hrough a ?ontra#torD
SHELTERS OR REST ROOMS AND LUNCH ROOMS21. a) 're there adeBuate E suitable shelters or rest
Rooms pro%ided in the fa#tory as reBuired under
Se#tion 4*D
b) 're there adeBuate and suitable mu#h rooms
ro%ided in the fa#tory as reBuired under
Se#tion 4*D
CRECHES
22. s there a #rF#he pro%ided in the fa#tory as
ReBuired under se#tion 4,D
'ELFARE OFFICER
23. a) Number of +elfare 5ffi#ers reBuired to be'ppointed under se#tion 4-D
b) Number of +elfare 5ffi#ers appointed
ACCIDENTS
24. a) 7otal Number of a##idents (see eplanatory note)i) 6etal
ii) NonC6etal
b) '##ident in $hi#h $orers returned to $or "uring the year to $hi#h this returns relate.
i) '##idents ($orers inGured) o##urring during7he pre%ious year in $hi#h inGured $ors
Returned to $or during the year to $hi#h this
Return relates.
aa) Number of '##idents
bb) Man "ays lost due to '##idents
#) '##idents ($orers inGured) o##urring during the
re%ious year in $hi#h inGured $orers did not
Return to $or during the year to $hi#h this return relate toaa) Number of '##idents
bb) Man "ays lost due to '##idents
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SUGGESTION SCHEME
2&. a) s a suggestion s#heme in operation in the fa#toryD
b) f so: the number of suggestions
i) Re#ei%ed during the year ii) '##epted during the year
d) 'mount a$arded in #ash priHes during the year i) 7otal amount a$ardedii) Ialue of maimum #ash priHes a$arded
iii) Ialue of minimum #ash priHes a$arded
?ertified that the information furnished abo%e is to the best of my no$ledge and belief: #orre#t.
Sgna*+re o, *-e Manager
Da*e........./
planatory Note0 C
1. 7he a%erage number of $orers employed daily should be #al#ulated by di%iding the aggregate numof attendan#e on $oring days (that is: man days $ored) by the number of $oring days in the yea
re#oning attendan#e: attendan#e by temporary as $ell as permanent employed should be #ounted
all employees should be in#luded: $hether they are employed dire#tly or under #ontra#tors. 'ttendaon separate shifts (e.g. night and day shifts) should be #ounted separately. "ays on $hi#h the fa#t
$as #losed for $hate%er #ause and days on $hi#h the manufa#turing pro#esses $ere not #arried
should not be treated as $oring days. artial attendan#e for less than half a shift on a $oring
should be ignored: $hile attendan#e for half a shift or more or su#h day should be treated as attendan#e.
2. 6or seasonal fa#tories: the a%erage number of $orers employed during the $oring season and season should be gi%en separately. Similarly the number of days $ored and a%erage number of m
hours $ored per $ee during the $oring and offCseason should be gi%en separately.
3. 7he a%erage number of hours $ored per $ee means the total a#tual hours $ored by all $or
during the year e#luding the rest inter%als but in#luding o%ertime $or: di%ided by the produ#t of t
number of $orers employed in the fa#tory during the year and &2. n the #ase the fa#tory has $ored for the $hole year: the number of $ees during $hi#h the fa#tory $ored should be use
pla#e of the figure&2.
4. %ery person illed or inGured should be treated as one separate a##ident. f in one o##urren#e persons $ere inGured or illed: should be #ounted si a##idents.
&. n item 24(a): the number of a##idents: $hi#h too pla#e during the year: should be gi%en. n #ase nfatal a##idents only those a##idents: $hi#h pre%ented $orers from $oring for 4, hours or m
should be indi#ated.
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FORM NO/ III
Ann+a0 Re*+rn ,or *-e ear #22&
res#ribed under se#tion 1,() of the Minimum +ages '#t: 1-4, abd Rule 21 (4C') of the .. Minimum
+ages Rules: 1-&-
Note0 nformation may be gi%en only for those #ategories of $orers in respe#t of $hom minimum $ages h
been fied under the minimum $ages a#t: 1-4,.
1. Name of stablishment $ith full postal address0
2. No. of days $ored during the year0
'dults ?hildren3. No. of Man days $ored during the year ========= ========
(7otal 'ttenden#e)
4. '%erage No. of persons employed daily during7he year ========= =========
&. 7otal +ages aid Rs.=============
. ?ash Ialue of +ages aid in >ind
*. "edu#tions made on a##ount of
6ine "amage or oss rea#h of ?ontra#t
No. of ?ases 'mount No. of ?ases 'mount No. of ?ases 'mount
,. alan#e of the fine fund at the beginning of the year ==================
-. "isbursement from the fine fund0 C
urpose 'mount Spent
a) ============================= ==============================
b) ============================= ===============================
#) ============================= ===============================
d) ============================= ===============================
1A. alan#e of fine fund at the end of the year0 =============================
Sgna*+re o, *-e Manager
"ate JJJJJJJJ
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FORM I$
ANNUAL RETURNS UNDER THE PAYMENT OF 'AGES ACT 1!3
'AGES AND DEDUCTION FROM 'AGES5
RETURN FOR THE YEAR ENDING 31ST DECEMER #22&
1. a) Name of the fa#tory or establishment and postal address
b) ?ode No.
#) ndustry
2. Number of days $ored during the year03. a) No. of Man days $ored during the year0
b) '%erage daily No. of persons employed during the year0
ersons re#ei%ing ersons re#ei%ing Rs. 1AAA andess than Rs. 1AAA more but less than Rs. 1AAAA
'dults
?hildren
a) 9ross amount paid as remuneration to persons getting less than Rs. 1AAA in#luding dedu#tions und
se#tion * (2) JJJJJJJJ.. of $hi#h the amount due to profit sharing bonus is
JJJJJJJJJ.. and that due to money %alue of #on#ession is JJJJJJJJJJJJ b) 9ross amount paid as remuneration to persons getting Rs. 1AAA and more but less than 1AAAA
in#luding dedu#tions under se#tion * (2) JJJJJJ of $hi#h the amount due to profit sharing
bonus is JJJJJJJ. 'nd that due to money %alue of #on#ession is JJJJJJJJJ..<
4. To*a0 6age7 8a9 n:0+9ng 9e9+:*on7 +n9er 7e:*on " (#) on *-e ,o00o6ng a::o+n* 0C
ersons re#ei%ing less ersons re#ei%ing Rs. 1AAA an
7han Rs. 1AAA more but less than Rs. 1AAAA
a) asi# $ages in#luding o%er time
+ages and nonCprofit sharing
onus b) "earness and other allo$an#e
n #ash
#) 'rrears of pay in respe#t of pre%ious
@ear paid and during the year.
;/ N+<=er o, :a7e7 an9 a<o+n* rea0>e9 a7? @
ersons re#ei%ing less ersons re#ei%ing Rs. 1AAA and
7han Rs. 1AAA more but less than Rs. 1AAAA
No. of ?ases 'mount No. of ?ases 'mount
a) 6ines
b) "edu#tion for "amages or oss#) "edu#tion for rea#h of ?ontra#t
. "isbursement 6rom 6ines fund0 urpose 'mounta)
b)
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*. alan#e of fines fund in hand at the end of the year Rs. JJJJJJJJJ.
Signature JJJJJJJ.
"esignation JJJJJJ.
• 7his is the aggregate number of attendan#e during the year. 7he a%erage daily number person
employed during the year is obtained by di%iding the aggregate number of attendan#e during
year by the number of $oring days.
• Money %alue of #on#essions should be obtained by taing differen#e of the #ost pri#e paid by
employer and the a#tual pri#e paid by the employees for supplier of essential #ommodities gi%
free or at #on#essional rates.
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MATERNITY ENEFIT ACT 1!1
FORM ‘N’
(See rule 1)
(M'7RN7@ N67 R8S: 1-*3)
"etails of payment made during the year ending 31st "e#ember 2AA,
M/S
Name of person to $hom paid ============= 'mount paid =============
1. "ate of payment ===============
2. +oman mployee ===============
3. Nominee of $oman ===============
4. egal representati%e of $oman ===============
&. 'mount for the period pre#eding date of epe#ted deli%ery ===============
. 'mount of the subseBuent period ===============
*. 8nder se#tion , of the '#t ===============
,. 8nder se#tion - of the '#t ===============
-. 8nder se#tion 1A of the '#t ===============
1A. Number of the $oman $orers $ho abs#onded after re#ei%ing the first installment of
maternity benefits ===============
11. ?ases $here #laims $ere #ontested in a #ourt of la$ ===============
12. Result of su#h #ases ===============
13. Remars ===============
SIGNATURE OF THE EMPLOYER
"ate =============
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MATERNITY ENEFIT ACT 1!1
FORM LB
(See Rule 1)
ANNUAL RETURN FOR THE YEAR ENDING 31ST DECEMER #22&
1 Name of the stablishment M/S
2 'ddress of the establishment: .5. "istri#t
3 "ate of opening the establishment
4 "ate of #losing: if #losed
& ostal address of the establishment
Name of the mployer: postal address of themployer
* Name of Managing 'gent: if any: ostal
'ddress of Managing 'gent
, Name of 'gent or Representati%e of employer:
ostal address of Representati%e of mployer
- Name of Manager: ostal address of Manager
1A (a) Name of Medi#al 5ffi#er: if any atta#hed tothe establishmentD
(b) Kualifi#ation of medi#al 5ffi#er atta#hed to
the establishment
(#) s he resident at the establishmentD(d) f a part time employee: ho$ often does he
pay %isit to the establishmentD
11 (a) s there any hospital atta#hed to the
establishmentD
(b) f so: ho$ manyu beds are pro%ided for$omen employeesD
(#) s there a lady "o#torD
(d) f so: $hat are her Bualifi#ationsD
(e) s there a Bualified Mid$ifeD(f) as any ?re#h been ro%idedD
"'70 C
SIGNATURE OF THE EMPLOYER
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For< 3;
HALF YEARLY RETURN
6or the eriod ending 3Ath Lune ===========
Name of 6a#tory 0 M/s
Name of 5##upier 0 Mr.
Name of the Manager 0 Mr.
1. "istri#t 0
2. 6ull ostage 'ddress of 6a#tory 03. Nature of ndustry 0
4. '%erage No. of mployees $ored 0
Men 0+omen 0
'dults
Men ================== +omen ===============
?hildernMen ==================
+omen ===============
&. 7otal Number of ours $ored at the end of -11A4 hrs
31st "e# 2AA, during the alf @ear ======= "ays
Signature of 5##upier Sgna*+re o, Manager
• 7he a%erage number of $orers employed daily should be #al#ulated by di%iding the aggrega
number of attendan#e on $oring days (that is man days $ored) by the number of $oring d
in the last si months. n re#oning attendan#e: attendan#e by temporary as $ell as permanentemployed should be #ounted and all employees should be in#luded: $hether they are employe
dire#tly or under #ontra#tors. 'ttendan#e on separate shifts (e.g. night and day shifts) should b
#ounted separately. "ays on $hi#h the fa#tory $as #losed for $hate%er #ause and days on $h
the manufa#turing pro#esses $ere not #arried on should not be treated as $oring days.• artial attendan#e for less than half a shift on a $oring day should be ignored: $hile attenda
for half a shift or more su#h day should be treated as full attendan#e
?ertified that the information furnished abo%e is to the best of my no$ledge and belief: #orre#t.
"ate JJJJJJJJJJ.. Sgna*+re o, *-e Manager
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'ORMEN’S COMPENSATION
Return relating to period from LanC2AA, to 31st "e#C2AA,
State 0
"istri#t 0
7o$n or Iillage 0
ost 5ffi#e 0
Name of stablishment 0
Name of +or 0
'%erage Numbers mployed er day 0 ====================================
'dults (Men) 0
Minors (+omen) 0
'##idents 5##upational "iseases
Number of #ases of inGuries inrespe#t of $hi#h final
#ompensation has been paid
during the year
'mount of #ompensation paid Number of #ases of diseases inrespe#t of $hi#h final
#ompensation has been paid
during the year
'mount of #ompensation pa
" e a t h
3 e r m a n e n t
" i s a b l e m e n t
7 e m p o r a r y
" i s a b l e m e n t
" e a t h
3 e r m a n e n t
" i s a b l e m e n t
7 e m p o r a r y
" i s a b l e m e n t
" e a t h
3 e r m a n e n t
" i s a b l e m e n t
7 e m p o r a r y
" i s a b l e m e n t
" e a t h
3 e r m a n e n t
" i s a b l e m e n t
7 e m p o r a r y
' d u l t
M i n o r s
"ate0JJJJJJJJJ SignatureJJJJJJJJJJJJ
"esignationJJJJJJJJJJJ
Note4s0 C1. n #ase $here more establishment than one are o$ned by the same employer: a separate return should be furnished for
establishment. +hen in any establishment the $ormen employed fall in t$o or more of the distri#t #ategories to $hi#h the r
relates: e.g. in the #ase of a tea estate #ategories ' and (%) a separate sheet should be used for the statisti#s of ea#h #ategory
2. nter the #lass of establishment a##ording to the pro#ess or produ#t: e.g. #otton $ea%ing and spinning fa#tory: #oal mine.3. n#lude all employees $hether permanent or temporary $ho $ould: in the #ase of a##idents be eligible for #ompensation u
the a#t and for $hom a return is reBuired to be furnished. Numbers employed should be sho$n e%en if there are no paymen
#ompensation to report.4. n#lude only those #ases in $hi#h the final payment of #ompensation $as made during the year. ' deposit $ith #ommiss
should be treated as a payment of the employer.
&. n#lude all #ompensation paid in respe#t of the #ases mentioned in footnote (4): $hether su#h #ompensation $as paid durin
year or pre%ious to its #ommen#ement. #lude all payments in #ases in $hi#h the final payment had not been made by the en
the year to $hi#h the return relates.. 5nly su#h disablement as last for more than se%en days should be sho$n ;Se#tion (4) ()(d) of the '#t<
*. +here the benefit a#tually allo$ed (e.g. hospital lea%e on full pay) is in e#ess of the #ompensation admissible under the a#t:
the amount of #ompensation so admissible should be entered in the return.,. IiH: anthra: lead poisoning: phosphorus poisoning: mer#ury poisoning: benHene poisoning: #hrome ul#eration and #ompre
air illness only.
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MATERNITY ENEFIR ACT 1!1
FORM ‘O’
(See rule 1)
(HIMACHAL PRADESH MATERNITY ENEFIT RULES 1!"3)
rose#ution during the year ending 31st "e#ember 2AA,
M/S
la#e of employment of
the $omen employee
Number of #ases instigated Number of #ases $hi#h
resulted in #on%i#tion
Remars
SIGNATURE OF EMPLOYER
"ated0 =======================
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MATERNITY ENEFIT ACT 1!1
FORM MB
(See Rule 1)
EMPLOYMENT DISMISSAL PAYMENT OF ONUS ETC/ OF 'OMEN FOR THE YEAR ENDIN
ON 31ST DECEMER #22&
1 Name of ;the Mine or ?ir#us<
2 'ggregate number of $omen permanently or temporarily employed duringthe year
3 Number of $omen $ho $ored for a period of not less than ;eighty days< in
the t$el%e months immediately pre#eding the date of deli%ery
4 Number of $omen $ho ga%e noti#e under se#tion
& Number of $omen $ho $ere granted permission to remain absent onre#eipt of noti#e of #onfinement
Number of #laims for maternity benefit paid
* Number of #laims for maternity benefit reGe#ted
, Number of #ases $here preCnatal: #onfinement and postCnatal #are $as pro%ided by the management free of #harge (se#tion ,)
- Number of #laims for medi#al bonus paid (se#tion ,)
1A Number of medi#al #laims for medi#al bonus reGe#ted.
11 Number of #ases in $hi#h lea%e for mis#arriage ;M7< $as granted.
12 Number of #ases in $hi#h lea%e for mis#arriage ;M7< $as applied for but
$as reGe#ted.a) Number of #ases in $hi#h lea%e for tube#tomy operation under
se#tion -' $as granted.
b) Number of #ases in $hi#h lea%e for tube#tomy operation $asapplied for but $as reGe#ted.
13 Number of #ases in $hi#h additional lea%e for illness under se#tion 1A $asgranted
14 Number of #ases in $hi#h additional lea%e for illness under se#tion 1A $asapplied for but $as reGe#ted.
1& Number of $omen $ho died
a) efore deli%ery. b) 'fter deli%ery.
1 Number of #ases in $hi#h payment $as made to persons other than the$oman #on#erned
1* Number of $omen dis#harged or dismissed $hile $oring
1, Number of $omen depri%ed of maternity benefit and / or medi#al bonus
under pro%ision to sub se#tion (2) of se#tion 12
1- Number of #ases in $hi#h payment $as made on the order of the?ompetent 'uthority or nspe#tor
2A Remars
N.. 6ull parti#ulars of ea#h #ase and reasons for the a#tion taen under serials *: 1A: 12: 14: 1* and 1, should
gi%en in 'ppendi belo$0C
"'70 C
SIGNATURE OF THE EMPLOYER
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FORM $B
;See Rule ,2(2)<
ANNUAL RETURNS OF PRINCIPAL EMPLOYER TO E SENT TO THE REGISTERING OFFICE
ENDING YEAR ON 31ST DECEMER #22&
1 6ull name and address of the rin#ipal mployer
2 Name of stablishment
(a) "istri#t(b) ostal 'ddress
(#) Nature of operations / industry / $or #arried on
3 6ull name of the Manager or person responsible for super%ision and #ontrol
of the establishment
4 No. of #ontra#tors $ho $ored in the establishment during the year (9i%e
details in 'nneure)
& Nature of $or / operation on $hi#h #ontra#t labour $as employed
7otal number of days during the year on $hi#h #ontra#t labour $as
employed
* 7otal number of days maydays $ored by #ontra#t labour during the year
, Maimum No. of $ormen employed dire#tly on any day during the year
- 7otal no. of days during the year on $hi#h dire#t labour $as employed
1A 7otal No. of maydays $ored by dire#tly employed $ormen
11 ?hange: if any: in the management of the establishment: its lo#ation or anyother parti#ulars furnished to the Registering 5ffi#er in the appli#ation for
Registration indi#ating also the date
la#e0 >umarhatti
"'70 C
PRINCIPAL EMPLOYER
'NNO8R 75 65RM
Name and address eriod of ?ontra#t Nature of Maimum No. of No. of
5f the ?ontra#tor 6rom CC to oCC +or No. of $orers days Monda
mployed by ea#h $ored
$ored?ontra#tor
1 2 3 4 &
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FORM I$B
;See Rule ,2(1)<
RETURN TO E SENT Y THE CONTRACTOR TO THE LICENSING OFFICER
HALF YEAR ENDING ON
1 Name and address of ?ontra#tor
2 Name and address of stablishment
3 Name and 'ddress of rin#ipal mployer
4 "uration of ?ontra#t 6rom to
& No. of days during the half year on $hi#h
a) the establishment of the prin#ipal employer had $ored b) the #ontra#tors establishment had $ored
Maimum number of #ontra#t labour employed on any day
during the half year0
Men
'o<en
C-09ern* i) "aily hours of $or and spread o%erP
ii) (a) +hether $eely holidays obser%ed and on $hatday
(b) f so: $hether it $as paid forP
iii) Number of man hours of o%ertime $oredP
, Number of mandays $ored byC
Men
'o<en
C-09ern
- 'mount of $ages paid
Men
'o<en
C-09ern
1A 'mount of dedu#tions from $ages: if anyC
Men
'o<en
C-09ern
11 +hether the follo$ing ha%e been pro%idedi) ?anteen
ii) Rest Rooms
iii) "rining $ater
i%) ?re#hes%) 6irst 'id
(if the ans$er is yes! state briefly standards pro%ided)
la#e0 >umarhatti
"'70 C
Sgna*+re o, Con*ra:*or
7/23/2019 AR Under Factory Act 1948
http://slidepdf.com/reader/full/ar-under-factory-act-1948 18/19
FORM D5
See R+0e ;5
'nnual return bonus paid to employees for the a##ounting year ending on 31.A3.2AA,
1. Name of stablishment and its #omplete postal M7
2. Name of ndustry M7
3. Name of mployer
4. 7otal Number of mployee
&. Number of employees benefited by bonus payments
1 2 3 4 &
7otal amount
payable as bonus
under se#tion 1Aor 1 of the
ayment of
onus '#t: 1-&as the #as may be
Settlement if
any: rea#hed
under se#tion1,(1) or 12(3)
of the
ndustrial"ispute '#t:
1-4* $ith
date
er#entage of
onus
de#lared to be paid
7otal amount of
bonus a#tually
paid
"ate on $hi#h
payment made
+hether
bonus has
been paid toall the
employees if
not: reason for non payment
Rema
R7/ NIL &/33 R7/ Pa9 *o a00e0g=0e
e<80oee
N
For
A+*-or7e9 Sgna*or
6or$arded to 0 7he abour 5ffi#er ?um ?ontrolling 'uthority under ayment of onus '#t: Solan
7/23/2019 AR Under Factory Act 1948
http://slidepdf.com/reader/full/ar-under-factory-act-1948 19/19
Ref. "ate0
7o7he abour ?ommissioner ?umC
?hief nspe#tor of 6a#tories:
Shimla ima#hal radesh
Sub. Submission of 'nnual Return 2AA,
R/Sir:
lease find en#losed here$ith the follo$ing do#uments0
1. 'ppli#ation in pres#ribed formC34 (Re%ised)
2. +ormen!s ?ompensation3. 'ppli#ation form No.
4. 'ppli#ation form No. I
&. Maternity enefit '#t: 1-1 6orm Q. Maternity enefit '#t: 1-1 6orm QN
*. Maternity enefit '#t: 1-1 6orm Q5,. Maternity enefit '#t: 1-1 6orm QM
-. ayment of onus '#t: 1-& 6orm Q"1A. alf yearly Return 6orm 3&
11. rin#ipal mployer Return 6orm C 2&
>indly do the needful and oblige.
7haning you.
@ours 7ruly:For
A+*-or7e9 Sgna*or