FORM B
[See Sec. 4(l) proviso (b) (i)]
Register of wages required to be maintained by small establishments
(To be maintained within seven days of the expiry of the wage period)

Name of establishment……………   Name and address of employee……………
Address (Local)………………….     Name of work…………………………….
(Permanent)………………………     Wage period………………………………

Serial Number	Name of the employee	Sex	Designation
1	2	3	4

Classification Whether per- anent/temporary/Casual/part-time or worked	Father’s or husband name	Total Days/number of unit
5	6	7

Wages earned

Basic allowance	Wage Statutory Minimum rate	Dear-ness	Over-time Actual	Bonus Gratuity Or exgratia
8	9	10	11	12

Maternity benefits	Any other allowance	Total amount	Advance
13	14	15	16

Wages earned

Fine due to damage or loss by neglect or default	Provident fund Employees state Insurance Employers contribution Employees contribution Employers contribution Employees contribution				Other deductions indicating the nature
17	18	19	20	21	22

Total deductions	Net amount payable	Signature or thumb impression of employee with date	Signature of Inspector with date	Remarks
23	24	25	26	27

NOTES: 1. In case of deduction of any advance taken by an employee, the employer shall also indicate therein the number of instalments paid/total instalments paid/total instalments by which advance is to be repaid such as “5/20,6/20”, etc. The purpose of advance shall also be mentioned in the Remarks column.
2. In case of imposition of fines or deduction for damage or loss, the specific act or omission for which the penalty has been imposed has to be indicated in the Remarks column. A certificate shall also be recorded in the said column to the effect that an opportunity to show cause was given to the employee concerned before imposition of fine or deduction.
Signature of the employer with full name in capitals.
Date……………….
Place………………