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Sr.

No

Full Name
1
1
2
3
4
5

Sex
2

Age
3

Working Hours
Leave with wages Date of Entr
From
To
Balance Enjoyed
4
5
6
7
8
9

Interval for Rest OR Designation


Meal
1
From
To
10
11
12

2 3 4 5 6 7 8 9 ###

11#################################
13

TOTAL Rate per Earned Sa Eaened H Earned D. M All


########################### DAYS Rs.
RS
Rs.
RS
Rs.
WORKED
14
15
16
17
18

RS
19

20

Gross amtAdv
Rs.
RS
21

Loan
Rs.
22

PF.
RS
23

Fp.
Rs.
24

ESI
RS
25

PT
Rs.
26

IT
RS
27

LWF
Rs.
28

Total Dedu
RS
29
30

Net payablSignature
Rs.
31
32
Space for Revnue stamp & signature

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