FORMAR Annual Return forthe Year Ending 31st December (Prescribed under Rule 100) This retum is to be submit in triplicate slg with necessmy enclosure in iriplignts to the Inspector of Paetories having over the faetory belore the 3st Jamuary following: 1. Resistration No. 2. Name of the Factory or Tstablishanent 3. Address 4. Name and residential address of the occupier 5. Name and residential addbess of the Manager 6. ES] Employer's Code No. if any, 7. SSI Registration No. if any. 8. Nature of the industry and the products manufactured or services provided. 9. Total mumber of days: worked “the year 10. Adult Men ‘Adult Women [Adolescents’ \(a) Number of children without hnan-days worked certificate of fines \(b) Average Junber of persons Jemplovedime. \(c) Total Man hours: worked om over (a) Total amount of lo wages paid. IIs ry process declared dangerous (I yes, sltachod a Fist of such u/s 87 carried on? if so average no, of processes) workers employed in each process, 12. Total salaries and wages paid 13, (1) Total amount of Bonus paid (2) Rate Percentage of Bomus paid. 14, Total amount of Welfare Fund Contributed, (a) (b) te) «ad 3. Facilities Providedestablished as required by the Factories Act (tick ouly if applicable) Cooled Drinking Water is 18 Safety Officers Ws 40-8 Ambulmee Room Us 48 Tull time Put timeRetainer basis Medical Cilicer16 uv fe) Canteen Wis 46: UW) Shellen’Rest or Rooms Uis fg) Creche U's 48: Qi) Welline Officer Tis 19. {2} Total Number of Fatal accidents. (b) Total number of nonfatal aceidenits (o} Man days lost due to nenefatal accidents. (a) Noof cases matemity benefit claimed paid. (b} No. of cases Medical bonus claimed/paid (c} No.of cases lesve for miscarriage applied granted. (a) No.of cases additional leave fos illness applied/aranted. fe) Total amount of matemity benefit paid (a) No.of workers who were entitled to annual leave with the wages during. the year (b) No.of workers wha were allowed to ananal leave with the wages during the year (e) Total smnount pati towards snimmal Jeave with wages encashment Date: Signature of Occupier/Manager the average munber of workers employed daily should be calculated by dividing the agoreaate number of attendance oc working days (thot is, man-days worked) by the unmber of working days in the year. In reckoning altendan should be counted, and all employees should be included, whether they are employed directly ar under contractors. attendance by temporary as well ax permanent workers employed Attendance on separate shifts (e.g. night and day shifts) should be counted separately. Days on-which the factory was closed for whatever causes and days on which the manufacturing process were not caitied on should no be treated as working days, partial attendance for less than half a shift