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FORM XXI : REGISTER OF FINES

[Rule 78(1)(a)(ii)]

Name and address of contractor

_______________________________

Name and address of establishment in / under which contract is carried on ___________________________________

Nature and location of work

_______________________________

Name and address of Principal employer ___________________________________

 

Sl. No.

Name of workman

Father’s / Husband’s Name

Designation / Nature of employment

Act / Omission for which fine imposed

Date of offence

1

2

3

4

5

6

 

 

 

 

 

 

 

Whether workman showed cause against fine

Name of person in whose presence employee ‘s explanation was heard

Wage periods and wages payable

Amount of fine imposed

Date on which fine realized

Remarks

7

8

9

10

11

12

 

 

 

 

 

 



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