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[FORM D
(See rule 5)
Annual Return-Bonus paid to employees for the accounting year ending on the……….

1. Name of the establishment and is complete postal address………………………...

………………………………………………………………………………………………
………………………………………………………………………………………………
2. Nature of the Industry………………………………………………………………
3. Name of the Employer……………………………………………………………...
4. Total Number of employees………………………………………………………...
5. Number of employees benefited by bonus payments………………………………
………………………………………………………………………………………………

1 2 3 4 5 6 7
Total amount Settlement, Percentage Total amount Date on Whether bonus Remarks
payables as if any reached of bonus of bonus which has been paid
bonus under under sec. 18 declared to actually paid payment to all the
Sec. 10 or 11 (1) or 12 (3) be paid made employees. If
of the Payment of not, reason for
of Bonus Act, the Industrial non-payment
1965 as the Disputes Act.
case may be 1947 with
date

Signature of the Employer or his agent.]