You are on page 1of 3

Contract Labour (R & A) Central Rules FORM XVII [See Rule 241(1) (a)] Name & Address of establishment

FORM XVII [See Rule 241(1) (a)] Name & Address of establishment in/ under w

Name & Address of Contractor :- Telecon Systems C-42 Sector -6 Hyeopseong Eng. Pvt. Ltd.
Noida U.P.

Name & Address of Principal Employer:-Samsu


Name & Location of Work :- Registor of Wages
C&I Erection Package Wages for the Month of :- Sept-18
SR.N

WORK MAN SR.NO.

O.T. AMOUNT

Other cash payment

TOTAL AMOUNT
No. of days worked

Units of work done

Rate
O.

O.T.HOURS

O.T. Rate
Amount
NAME OF WORKMAN Fathers Name Designation DEDUCTION

1 2 3 4 5 6 7 8 10 11 12
P.F.

Dhanajay Kumar Rajendra


1 3 Signal Man 10,000 0 - 71.0 0 0
Chaudhary Chaudhary

Prithvee
2 Ranjeet Kumar 5 Signal man 10,000 0 71.0 0 0
Sharma
shment in/ under which Contract is carried on:-

pal Employer:-Samsung India Pvt. Ltd. Noida, U.P.

Sept-18
TOTAL DEDUCTION

UCTION

13
ESIC

0
Staff Attendence for month of Aug-2018
Sr. No Name No of work days
1 Alok Srivastava 31
2 Manish Dubey 20
3 H. M Singh 31
4 Raushan Singh 20
5 Akhilesh Kumar 28
6 Nitish 31
7 Amit Chaurasiya 31
8 vinay 26
9 S. K Lal Mohan 31
10 Saurya 31