FORM No.

15
LEAVE BOOK
(Prescribed under Rule 121)
(Shall be the same as “Register of Leave with Wages” (Form No. 14), but shall be made out separately for each worker on a thick bound
sheet).

REGISTER OF LEAVE WITH WAGES FOR THE YEAR . . . . . . . . . . . . . . . . .

Serial No. . . . . . . . . . . . . . . . . . . . Name of Factory . . . . . . . . . . . . . . . . . Particulars of Workers

Department . . . . . . . . . . . . . . . . . Licence No. . . . . . . . . . . . . . . . . . . . . . Adult / Child . . . . . . . . . . . . . . . . . . . . . . .
Serial No. in the Register of Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adult/Child Workers . . . . . . . . . . . . . . . . . Father’s Name. . . . . . . . . . . . . . . . . . . . . .
Date of entry into service . . . . . . . . . . . . . . . . . Date of Discharge . . . . . . . . . . . . . . . . . .
Date and amount of payment made in
 Number of day
Leave to
during the previous Date
Credit
year Whether Cash Rate of and
leave in equivalent of wages refere

leaveNo. of days of maternity

formedNo. of days work per-

No. of days of leave enjoyed

Leave Remarks
Total accordance Leave Balanc advantage for the nce to
earned Total of
No. of days of lay-off
and
of with enjoyed e of Normal accruing leave payme
during Columns 6 Initials of
Colu scheme from Leave rate of through period nt vide
mns 1
the & 7 Leave Manager
Balance under . . . . . . to at wages concessional (Total of wages for each
to 4 previou to credit
of Leave section ...... credit sale of Food- column Regist entry
s year
79(8) was grains and 12 and er or
refused other articles 13) vouch
er
Lieu
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
of leave
due . . . . . .
..........
...

Note : Separate Page will be allotted to each worker.