F O R M – IV

WAGE SLIP

(Regulation-9)

(i)	Name of the Contractor	:
(ii)	Place	:
1.	Name of the worker with father’s / husband’s name	:
2.	Nature of employment	:
3.	Wage period	:
4.	Rate of wages payable	:
5.	Total attendance / Unit of work done	:
6.	Dates on which overtime worked	:
7.	Overtime wages	:
8.	Gross wages payable	:
9.	Total deduction (indicating nature of deductions)	:
10.	Net wages payable	:
Contractor’s Signature / Thump Impression			Employee’s Signature / Thump Impression