FORM G

(See Rule 14)

Register of Employment & Remuneration

Year ………………..... Month ……………….. of …………..

Wage Period
(Where Different) ……………………………………………..

Name of Establishment ………………………………..

Name of Employee ……………………………………. Father’s Name …………………………..
Nature of Work ..……………………………………….. Rate of Wages …………………………..
Wage Period …………………………………………… Date of Employment …………………….

Hours of Interval for Hour Overtime C Privilege Leave Sign R

Works Rest & s Hour W asua Leav Leav Bala atur emar
Meals Wor s ages l or e e nce e of ks
Date F To F To ked Wor Earn sick Due Avail Own
rom rom with ked ed ness ed er or
the Leav Occ
Emp e upie
loyer Avail r
ed
duri
ng
the
Mon
th/W
age
Peri
od

Remuneration Due Deductions Net Date Signa

Amou of ture
nt Paym of
Paya ent Empl
ble oyee
Basic Overti Other Total Fines other Advance Paid Total
Salar me Allow & Dedu Date Amou
y or ances Dedu ction nt
Wage if any ctions
s on
accou
nt of
Dama
ge or
loss

Signature of Employer