Company Name Company

Salary Statement for the Month of _______ , 2007 Logo

Employee Name
Employee Number Joining Date
Account Number Designation
Days Present Paid Leaves
Arrears Days P.F. No.
Salary for the month Leave Without Pay
Earnings Deductions
Amount Amount
Basic Salary E.Provident Fund
Dearness Allowance ESI
HRA Professional Tax
Conveyance I. Tax
Medical Allowance Loan
Mobile Expenses Advance
Special Allowance Misc. Deduction
Performance Incentives
Arrears/ Other Ern.
Total Earnings Total Deductions
Rupees
Net Salary Rs.
For _______________________

E&O.E Authorized Signatory