FORM XVII

Name and address of contractor ..

Name & Address of establishment in/under

which contractor

(SEE RULE 78 (z) (a)

Name and location of work ...

.

is carried on

Register of wages
employees .
Name of workman
Designat
Sl.
ion of
No
workman
.

No. of
days
worke
d

Daily
rate of
wages

Amount
of
wages
earned

P.F.
deduction
12%

D.A.
Amount

Bonus
amount
8.33%
O.T.
days

C.L. +
Extra
days

Name & address of principal

O.T.
+C.L.
+EXTR
A
Amoun
t

Net
amount
paid

Signature/Thumb impression
of workman

Remarks