Labour Commissioner 
* (PRESCRIBED UNDER RULE 87 & 88 )
REGISTER OF LEAVE WITH WAGES
| Serial No. ......... | Name of factory...... | Adult/ Child ....... |
|---|---|---|
| Department........ | Name.......... | |
| Serial No. in the Register of Adult/ Child workers.... | Father's Name ..... | |
| Date of entry into service,.... | Date of Discharge...... | |
| Date of amount of payment in lieu of leave due ...... |
| Number of days worked during the calendar year | Leave to Credit | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Calendar year of Service | Wage Period From... To...... | Wages earned during the wages period | No. of days of work performed | No. of days of day-off | No. of days of maternity leave | No. of days leave enjoyed | Total of col. 4 to 7 | Balance of leave from preceding year | Leave earned during the year mentioned in col. 1 |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| Total of cols. 9 to 10 | Whether leave in accordance with scheme under section 79(8) was refused | Leave enjoyed From.... to...... No. of days......... | Balance of leave to credit | Normal rate of wages | Cash equivalent of advantage according through concessional sale of food grains & other articles | Rate of wages for the leave period (total of cols. 15 & 16) | Remarks |
|---|---|---|---|---|---|---|---|
| 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 |