1

[Form - T
COMBINED MUSTER ROLL CUM REGISTER OF WAGES
[See Rule 24 (9-B) of Karnataka Shops & Commercial Establishment Rules, 1963]

1. Forms I & II of Rule 22(4); Form IV of Rule 28(2);Forms V and VII of Rule 29(1) and (5) of the Karnataka Minimum Wage
2.Form I of Rule 3(1) of the Karmataka Payment Wages Rules,1963.
3. Form XIII of Rule 75;Forms XV,XVII,XX,XXI,XXII and XXIII of rule 78(1)(a)(i),(ii) and (iii) of the Contract labour ( Regulat
4. Form XIII of Rule 43;Forms XVII,XVIII,XIX,XX,XXI and XXII of Rule 46(2)(a),( c) and (d) of inter State Migrant Workmen

Month / Year
Name & address of the establishment: Owl Tech Pvt Ltd., Brookfields, Bangalore

S.No Building Location Emp ID Name of the employee

Name

1 2

Legend:
SL Sick Leave
CL Casual Leave
PL Previlage Leave
HS Half Sick Leave
HC Half Casual Leave
HP Half Previlage Leave

ML Maternity Leave
LOP Loss of pay
WO Weekly off
NFH National Festival Holiday
WFH Work From Home
OD On Duty (On site job / On duty job)
e 29(1) and (5) of the Karnataka Minimum Wages rules 1958.

a)(i),(ii) and (iii) of the Contract labour ( Regulation and Abolition) (Karnataka ) Rules,1974
(a),( c) and (d) of inter State Migrant Workmen( Regulation of Employment and Conditions of Service)Karnataka Rules, 1981

Name & address of the employer: Owl Tech Pvt. Ltd., SP

Bangalore

Father / Husband Name Male/Female Designation / Date of Date of Date of ESI No.
department joining Birth Leaving

2 3 4 5 6
 in lieu of

taka Rules, 1981

PF No Wages fixed Leave date Leave date to No. of days Type of leave No. of
including From leave taken payable
VDA Days

7 8 10
Total OT
hours Earned wage and other allowances
worked Basic DA/VDA HRA Conveya Med. Attendan Special OT
nce Allowanc ce bonus Allow.
e
11 12 13 14 15 16 17 18 19
 Month / Year
nd other allowances
NFH Maternity Others Subsistanc Leave Total ESI PF PT
Benefit e Encashment
allowance
20 21 22 if any
23 24 25 26 27
 Net
Deductions Payable
TDS Society Insuranc Sal. Adv. Fines Damages / Others Total
e Loss

28 29 30 31 32 33 34 35 36
Mode of payment Employee
Cash / Cheque No. signature /
Thumb
impression

37 38