FORM XVI

[See Rule 78 (2) (a)]

Muster Roll

Name and address of establishment in / under which BRIWO Solutions Pvt Ltd, D-19, Plot 1, Ip extension
Name and address of Contractor BRIWO Solutions Pvt Ltd
contract is carried on New Delhi-110092

Nature and location of work IT Contract Staffing, New Delhi BRIWO Solutions Pvt Ltd, D-19, Plot 1, Ip extension
Name and address of Principal Employer
New Delhi-110092
For the month of Feb-22

Dates
Sl. Father's / Husband's
Name of workman Sex
No. name
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

1 Somil Aggarwal Manoj Agarwal M P P P P P P P P P P P P P P P P P P P P P P P

2 Arvind Vyas Data Ram M P P P P P P P P P P P P P P P P P P P P P P P

10

11

12

13

14
2 2 2 2 0 0 2 2 2 2 2 2 0 0 2 2 2 2 2 2 0 0 2 2 2 2 2 2 0 0 2
 FORM XVI
e Rule 78 (2) (a)]
Muster Roll

BRIWO Solutions Pvt Ltd, D-19, Plot 1, Ip extension,

New Delhi-110092

BRIWO Solutions Pvt Ltd, D-19, Plot 1, Ip extension,

New Delhi-110092

Remarks

23

23

0
46
 FORM XVII
[See Rule 78 (2) (a)]
Register of Wages

BRIWO Solutions Pvt Ltd, D-19, Plot 1, IP extension, New

Name and address of Contractor
Delhi-110092
Name and address of Establishment BRIWO Solutions Pvt Ltd, D-19, Plot 1, IP
in/under which contract is carried on extension, New Delhi-110092
Nature and location of work IT Contract Staffing, New Delhi

BRIWO Solutions Pvt Ltd, D-19, Plot 1, IP

Wage period: Feb-22 Name and address of Principal Employer
extension, New Delhi-110092

Other cash
Serial No, in Daily rate payments Other
Serial Designation / Nature of No. of days Units of Dearness
Name of workman the register of wages / Basic wages Overtime (nature of Gross Wages PF ESI PT deduction if
Number work done worked work done allowance
of workmen piece rate payment to any
be indicated)

1 Somil Aggarwal E24072 Software Developer 23 23 1863 727 727 0 0 0

2 Arvind Vyas E10041 Software Developer 23 23 1863 727 727 0 0 0

3 0

4 0

5 0

6 0

7 0

14 0

15 0

16 0

Total 46 46 3726 1454 0 0 0 1454 0

 FORM XVII
ee Rule 78 (2) (a)]
egister of Wages

Signature /
Initials of
Net amount Thumb
contractor or his
paid impression of
representative
workman

727 SA

727 AV

1454
 FORM XIX
[See Rule 78 (2) (b)]
Wage Slip

BRIWO Solutions Pvt Ltd, D-19,

Name and address of Name and Father'sname of the Somil Agarwal S/O Manoj
Plot 1, IP extension, New Delhi-
Contractor workman Agarwal
110092

For the Week / Fortnight / Month

Nature and location of work IT Contract Staffing, New Delhi Feb-22
ending

1 No. of days worked 23

2 No. of units worked in case of piece rate workers 23

3 Rate of daily wages / Piece rate 1863

4 Amount of Overtime wages

5 Gross Wages payable 42849

6 Deductions, if any

7 Net amount of wages paid 42849

Initials of the Contractor or his representative

 FORM XIX
[See Rule 78 (2) (b)]
Wage Slip

BRIWO Solutions Pvt Ltd, D-19,

Name and address of Name and Father'sname of the
Plot 1, IP extension, New Delhi- Arvind Vyas S/O Data Ram
Contractor workman
110092

For the Week / Fortnight / Month

Nature and location of work IT Contract Staffing, New Delhi Feb-22
ending

1 No. of days worked 23

2 No. of units worked in case of piece rate workers 23

3 Rate of daily wages / Piece rate 1863

4 Amount of Overtime wages

5 Gross Wages payable 42849

6 Deductions, if any

7 Net amount of wages paid 42849

Initials of the Contractor or his representative

 FORM XX
[See Rule 78 (2) (d)]
Register of Deductions for Damage or Loss

Name and address of Contractor

Name and address of Establishment in/under which contract is carried on

Nature and location of work

Name and address of Principal Employer

Name of Date of recovery

Whether person in
Signature of
Particulars of worker whose Amount of
Sl. Father's / No. of the employer
Name of workman Designation damage / Date of damage showed presence deduction Remarks
No. Husband's name installment or his
loss cause against employee's imposed First Last representative
deduction explanation installment installment
was heard

1 2 3 4 5 6 7 8 9 10 11 12 13 14
January-2010

February-2010

March-2010

April-2010

May-2010

June-2010

July-2010

August-2010

September-2010

October-2010

November-2010
December-2010
 FORM XXI
[See Rule 78 (2) (d) (v)]
Register of Fines

Name and address of Contractor

Name and address of Establishment in/under which contract is carried on

Nature and location of work

Name and address of Principal Employer

Name of
Whether person in
Act/
workman whose Wage period Date on
Sl. Father's / Designation / Nature of Omission for Amount of
Name of workman Date of offences showed presence and wages which fine Remarks
No. Husband's name employment which fine is fine imposed
cause against employees payable realised
imposed
fine explanation
was heard

1 2 3 4 5 6 7 8 9 10 11 12
January-2010

February-2010

March-2010

April-2010

May-2010

June-2010

July-2010

August-2010

September-2010

October-2010

November-2010
December-2010
 FORM XXII
[See Rule 78 (2) (d)]
Register of Advances

Name and address of Contractor

Name and address of Establishment in/under which contract is carried on

Nature and location of work

Name and address of Principal Employer

No. of Date and

Purposes for Date on
Wage period installments amount of
Sl. Father's / Designation / Nature of Date and amount which which last
Name of workman and wage by which each Remarks
No. Husband's name employment of advance given advance installment
payable advance to installment
made was paid
be repaid repaid

1 2 3 4 5 6 7 8 9 10 11
December-2010
 FORM XXIII
[See Rule 78 (2) (e)]
Register of Overtime

Name and address of Contractor

Name and address of Establishment in/under which contract is carried on

Nature and location of work

Name and address of Principal Employer

Total Initials of
Date on Date on Initials of
overtime authorised
Father's / Designation / which which contractor
Sl. Wages of Overtime worked or Normal Overtime Normal Overtime Total representati
Name of workman Husband's Sex Nature of Overtime Normal rate overtime or his
No. on each occasion production hours rate earnings earnings earnings ves of
name employment work is put payment representati
in case of principal
in made ve
piece rates employer

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
 FORM XXIV
[See Rule 82 (1)]

Return to be sent by the Contractor to Licensing Officer for the Half year ending____________.

1 Name and address of the Contractor

2 Name and address of the Principal Employer

3 Name and address of the establishment

4 Duration of contract From To:

No. of days during the half year on which contract labour was
5
employed
Maximum number of contract labour employed on any day
during the half year
6 (i) Men
(ii) Women
(iii) Children

(i) Normal hours of work per day

(ii) (a) Whether weekly holiday observed

(b) If so, whether it was paid for

7
(iii) Particulars of rest interval and weekly spread over

(iv) Rate of overtime wages

(v) No. of man hours of overtime worked during the half year

Total number of man days worked by -

8 (i) Men
(ii) Women
(iii) Children

Total amount of wages paid

9 (i) Men
(ii) Women
(iii) Children

Total amount of deductions from wages, if any, effected

10 (i) Men
(ii) Women
(iii) Children

Whether the contractor has provided-

(i) Canteens
11 (ii) Rest Rooms
(iii) Drinking water
(iv) Creches
(v) First aid

(If the answer is 'yes' state brief the facilities provided therein)

Place:

Date: Signature of Contractor

 FORM XXV
[See Rule 82 (2)]
Annual Return of Principal employer to be sent to the Registering Officer

Return for the year ending 31st December

1 Full name and address of the Principal Employer

2 Name of Establishment

(a) District

(b) Postal address

(c) Nature of operations/industry/work carried on

Full name of the Manager or person responsible for supervision

3
and control of the establishment
Maximum number of workmen employed as contract labour on
4
any day during the year
Total number of days during the year on which contract labour
5
was employed
Total number of man days worked by contract labour during
6
the year
Maximum number of workmen employed directly on any day
7
during the year
Total number of days during the year on which directly
8
employed labour was employed
Total number of man days worked by directly employed
9
workmen

10 Nature of work on which contract labour was employed

Amount of security deposits made by Contractors. (Give

11
Contractor wise)
Amount of security deposits forfeited together with the names
12
of Contractor, if any

Whether there is any change in the management of the

establishment its location or any other particulars furnished to
13
Registering officer in the form of application for registration at
the time of registration. If so, from what date ?

Place:

Date: Principal Employer

ANNEXURE TO FORM XXV
Maximum
No. of
Name and Period of Contract Nature of workers
address of the No. of days worked No. of man days worked
work employed
Contractor
by each
From To contractor
1 2 3 4 5 6 7