F. V. No. Amount

Manual of Goa Laws (Vol. II) – 819 – Labour Welfare Fund Act & Rules

Receipts

Date Particulars Receipt No. L. F. Amount

XI. REGISTER OF QUARTERLY RECEIPTS OF UNPAID ACCUMULATIONS FROM THE ......... Name of Establishment ................................................. Amount No. .................... Period and Particulars (wage period) Reference of notice if issued Amount received Receipt No. and date Unpaid accumulations Interest First Quarter ending 31st March, 19

Second Quarter ending 30th June, 19

Third Quarter ending 30th September, 19 Fourth Quarter ending 31st December, 19 Bonus for the year declared on

_______________

Total _______________

First Quarter ending 31st March, 19

Second Quarter ending 30th June, 19

Third Quarter ending 30th September, 19 Fourth Quarter ending 31st December, 19 Bonus for the year declared on

_______________

Total _______________

First Quarter ending 31st March, 19

Second Quarter ending 30th June, 19

Third Quarter ending 30th September, 19 Fourth Quarter ending 31st December, 19 Bonus for the year declared on

_______________

Total _______________

Factory or establishment and publication of notice file No. ....................................... Factory Address ............................. Registered office 1st year Notice board Newspaper Notice board Newspaper

Manual of Goa Laws (Vol. II) – 820 – Labour Welfare Fund Act & Rules

Period and Particulars (wage period) 2nd year Notice board Newspaper Notice board Newspaper First Quarter ending 31st March, 19

Second Quarter ending 30th June, 19

Third Quarter ending 30th September, 19 Fourth Quarter ending 31st December, 19 Bonus for the year declared on

_______________

Total _______________

First Quarter ending 31st March, 19

Second Quarter ending 30th June, 19

Third Quarter ending 30th September, 19 Fourth Quarter ending 31st December, 19 Bonus for the year declared on

_______________

Total _______________ First Quarter ending 31st March, 19

Second Quarter ending 30th June, 19

Third Quarter ending 30th September, 19 Fourth Quarter ending 31st December, 19 Bonus for the year declared on

_______________

Total _______________ 3rd year Reference to Report to Inspector Inspector Report No. and date Remarks Notice Board Newspaper

XII. REGISTER OF PAYMENTS TOWARDS SETTLEMENT OF CLAIMS TO UNPAID ACCUMULATIONS VIDE SECTION 6 Name of the establishment ................................................ Account No. .......................... File No. ................................ Address: Factory/Registered Office .................................... Serial No. Name of the claimant Refund order No. and date Voucher No. and date Payment of unpaid accumulation from receipt As on Quarter ending Quarter ending Quarter ending Quarter ending Quarter ending 1 2 3 4 5 6 7 8 9 10 Amount received Date of first publication Serial No. Name of the claimant

Payment of unpaid accumulation from receipt Remarks Quarter ending

Quarter ending

Quarter ending

Quarter ending

Quarter ending

Quarter ending

Quarter ending

1 2 11 12 13 14 15 16 17 18 Amount received Date of first publication:

Manual of Goa Laws (Vol. II) – 821 – Labour Welfare Fund Act & Rules

FORM ‘D’ [See Rule 28(1) (a)] REGISTER OF WAGES Name of the establishment ........................................................................... For the month of ......................................... Serial No. Name of employees Ticket and Badge No. Amounts payable during the month Occupation Basic wages Overtime Dearness allowance and other allowances Bonus 1 2 3 4 5 6 7 8

Amount deducted during the month Basic wages Amount actually paid during the month Bonus Fines other deductions overtime Dearness allowance and other allowances 9 10 11 12 13 14

Balance due to the employees Basic wages Overtime Dearness allowances and other allowances Bonus 15 16 17 18

FORM ‘E’ [See Rule 28(1) (b)]

REGISTER FOR FINES AND UNPAID ACCUMULATION FOR THE YEAR ................

Name of the establishment ...........................................................................

Quarter ending 31st March Quarter ending 30th June Quarter ending 30th September Quarter ending 31st December 1. Total realization under fines 2. Total amount becoming unpaid accumulations of

1. (i) Basic wage
2. (ii) Overtime
3. (iii) Dearness allowances and other allowances Total of (1), (2) By order and in the name of the Governor of Goa. L. J. Menezes Pais, Under Secretary (Industries and Labour). Panaji, 29th January, 1990.

Manual of Goa Laws (Vol. II) – 822 – Labour Welfare Fund Act & Rules

Notification 21/15/90/LAB In exercise of the powers conferred by Sub-section (1) of section 3 of the Goa, Daman and Diu Labour Welfare Fund Act, 1986 (Act 4 of 1987) (hereinafter called the ‘said Act’), the Government of Goa hereby constitutes the Labour Welfare Fund for the purposes of the said Act. By order and in the name of the Governor of Goa. Subhash V. Elekar, Joint Secretary (Labour). Panaji, 24 th July, 1991.