Subs. by Act 33 of 2014, s. 6, for I Schedule and II Schedule (w.e.f. 1-1-2015). — AMENDING ACT

Subs. by Act 33 of 2014, s. 6, for I Schedule and II Schedule (w.e.f. 1-1-2015).

1. Subs. by Act 33 of 2014, s. 6, for I Schedule and II Schedule (w.e.f. 1-1-2015). THE SECOND SCHEDULE [See section 2(c)] FORM I [See section 4 (1)] ANNUAL RETURN (To be furnished to the Inspector or the authority specified for this purpose under the respective Scheduled Act before the 30th April of the following year) (ending 31st March__________________) Name of the establishment, its postal address, telephone number, FAX number, e-mail address and location______ ______________________________________________________________________________________________ Name and postal address of the employer______________________________ _____________________________ ______________________________________________________________________________________________ Name and address of principal employer, if the employer is a contractor__________ ________________________ ______________________________________________________________________________________________ Name of the Manager responsible for supervision and control____________________ _______________________ (i) Name of business, industry, trade or occupation carried on by the employer________________________ ________________________________________________________________________________________ (ii) Date of commencement of the business, industry, trade or occupation________ ________________________ ______________________________________________________________________________________________ Employer’s number under ESI/EPF/Welfare Fund/PAN No., if any______________ ________________________ Maximum number of workers employed on any day during the year to which this return relates to: Category Male Female Children (those who have not Highly Skilled Skilled Semi-skilled Un-skilled completed 18 years of age) Total Average number of workers employed during the year: Total number of mandays worked during the year: Number of workers during the year: (a) Retrenched : (b) Resigned : (c) Terminated : Retrenchment compensation and terminal benefits paid (provide information completely in respect of each worker)________________________________________________________________________________________ _________________________________________________________________________________________ Mandays lost during the year on account of— (a) Strike : (b) Lockout : (c) Fatal accident : (d) Non-fatal accidents : Reasons for strike or lockout : Total wages paid (wages and overtime to be shown separately): Total amount of deductions from wages made : Number of accidents during the years :

Section 1