+ Serial Number Tic#et Number Name in full Occu"ation "iece&timeRate of minimum $a%es 0 1 , . 2 3 4 5 +6 ++ +0 +1 +, +. +2 +3 mount *columns +,-+.

/ Other allo$ances anyRate of !earness llo$ance' if !ays "resent $or#edTotal days and (ours o)ertime Rate of o)ertime Total "iece rate "roductions Normal earnin%s O)ertime earnin%s Total $a%es earned ctual rate of $a%es

Period from Name of !e"artment

!earness allo$ance earned if any Wa%es "ayable

Form II-A

(See rule 5)

For the month of to

Name of factory or industrial establishment ..

Place ..

REGISTER OF W GES ..

+4 Fine bsence from duty !ama%e to or loss of %oods +5 06 0+ 00 01 0, 0. 02 03 04 05 16 1+ su""lied by the em"loyer(ouse accommodation mentities and ser)ices "ayment of $a%esReco)ery of ad)ances or for ad7ustment of o)er Income Ta8 !eductions re9uired to be made by the order of a :ourt or the com"etent authority Subscri"tions to or re"ayment of ad)ances from "ro)ident found Payment of :o-o"erati)e societies or to a scheme of insurance maintained by the Indian Post Office ; <Payment of "remium of life insurance "olicy or for the "urchase of Go)ernment of India or State Go)ernment securities or in furtherance of any Go)ernment sa)in%s scheme Total deductions Net amount Remar#s

Form II-A

(ere enter months if "ayment is made by the >ritish calendar month. In the case of other $a%e "eriods' enter <$ee#?' <fortni%ht? or <(a"ta? as the case may be' %i)in% the dates co)ered by the "ay "eriods. To be filled in by Factories co)ered by the @inimum Wa%es ct' +5,4 Where the rate of dearness allo$ance is uniform for all $or#ers' the rate may be mentioned a%ainst the first name only. To be filled in E A B.!. No. if $or#ers is em"loyed on "iece rate basis >y <Wa%es "ayable? is meant %ross $a%es earned by a $or#man. Cide G.N. PW ++2+&4444, *ii/-I' dated .-5-+521