FORM No.

14 [See Rule 120]

REGISTER OF LEAVE WITH WAGES FOR THE YEAR . . . . . . . . . . . . . . . . . Serial No. . . . . . . . . . . . . . . . . . . . $e%artme&t . . . . . . . . . . . . . . . . . Serial No. i& t*e Re+i"ter of A'!lt()*il' Wor#er" . . . . . . . . . . . . . . . . . $ate of e&try i&to "er-ice . . . . . . . . . . . . . . . . . Name of Factory . . . . . . . . . . . . . . . . . Lice&ce No. . . . . . . . . . . . . . . . . . . . . . artic!lar" of Wor#er" A'!lt ( )*il' . . . . . . . . . . . . . . . . . . . . . . . Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Fat*er," Name. . . . . . . . . . . . . . . . . . . . . . $ate of $i"c*ar+e . . . . . . . . . . . . . . . . . . $ate a&' amo!&t of %ayme&t ma'e i& Lie! of lea-e '!e . . . . . . . . . . . . . . . . . . . Number of days during the previous year
leaveNo, of days of maternity formedNo, of days &or3 per0 No, of days of leave en+oyed No, of days of lay0off Total of Columns 1 to 4

eave to Credit eave earned during the previous year Total of Columns ! " # eave to $redit %hether leave in a$$ordan$e &ith s$heme under se$tion #'()* &as refused eave en+oyed from , , , , , , to ,,,,,,

-alan$e of eave

-alan$e of eave at $redit

Normal rate of &ages

Cash e.uivalent of advantage a$$ruing through $on$essional sale of /ood0 grains and other arti$les 11

Rate of &ages for the leave period (Total of $olumn 12 and 11*

2ate and refere0 n$e to paym0 ent vide &ages Registe r or vou$0 her 16

Remar3s and 4nitials of 5anager for ea$h entry

'

10

11

12

14

1!

Note 7 Separate 8age &ill be allotted to ea$h &or3er,