FORM XIX

1[See rule 78 (1) (b)]

Wage Slip

Name and address of contractor ------------------------------------------------
Name and father's/husband's name of the workman-------------------------------
Nature and location of work ----------------------------------------------------
For the week/fortnight/month ending -------------------------------------------
1. Number of days worked -----------------------------------------------------
2. Number of units worked in case of piece rate workers ------------------------
3. Rate of daily wages/piece rate ----------------------------------------------
4. Amount of overtime wages -------------------------------------------------
5. Gross wages payable a ----------------------------------------------------
6. Deductions, If any ---------------------------------------------------------
7. Net amount of wages paid --------------------------------------------------
Initials of the Contractor or his representative. ---------------------------------