FORM 15

[Prescribed under Rules 87 and 88]

Register of leave with wages

Name of Factory Adult / Child

Serial No. Name

Department OPERATION Father's name

Serial No. in Register of

Date of discharge
Adult / Child workers

Date of entry into service Date and amount of payment made in lieu of leave due

Number of days worked during the calendar year Leave to credit

Cash
equivalent
of
Rate of
advantage
Numb Whether leave in Leave wages for
accruing
Calendar er of Balance Leave earned accordance with enjoyed Normal the leave
Wage period Wages Number Balance of leave through
year of Number of days Number of days Total of of leave during the year, Total of scheme under from… rate of period Remarks
from…….to earned of days to credit concession
service of work Days of lay- of Cols. 4 to from the year Cols. 9 Sec. 79(8) was …...to wages (Total of
during the of leave al sale of
performed off mater 7 preceding mentioned in Col. and 10 refused …….. Cols.15 and
wage period enjoyed food
nity year 1 16)
grains and
leave other
articles

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

2020 JAN'20 - - - - -

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2020 DEC'20 - - - - -