The Code on Wages (Central) Rules, 2026

Rule Form IV Form IV

Chapter: Annexures · Forms and Appendices
Text as on: As notified 08 May 2026

FORM-IV (See clause (ii) of sub rule (1) of rule 51)

Name of the

Establishment

Name of the

Employer

Name of the Owner

PAN/TAN of the

Employer

Registration Number of the establishment (Labour Identification Number (LIN) shall be the Registration Number of the Establishment)

Sr. No. Nam De De Duration of Wage Total no. of Total overtime Rate of

in e sig part Payment of wages Perio days hours worked or wages

Sl Employ of nati me (Monthly/ d worked overtime B D All . the on nt Fortnightly/Weekly From- during the N ee production in case as A ow

o. Registe empl / Daily/Piece rated) To wage of piece workers ic anc

r/ oyee period es

Employ

Code

(1) (2) (3) (4) (5) (6) (7) (8) (9) (1 (1 (12)

0) 1)

Amount of wages Deductions Net

earned Paymen

Bas DA All Ove Total EPF ESI Soc Inc Insu Adv Reco Recovery Tota Oth t ic ow rtim wages C iety om ranc ance very on l ers

anc e earned e e s of account Ded

es Tax Fine of uctio

Damages/ ns

Losses

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24) (25) (26) (27) (28)

Date of Receipt by Nature of acts Amount Damage or loss Signature of Payment employee/Bank and omissions for which fine of fine caused to the Employer/Employer transaction ID imposed with date imposed employer by Representative*

(30) neglect or default

of the employee

(28) (29) (31) (32) (33)

*Note: Required in case register is maintained physically.

FORM-IV
(See clause (ii) of sub rule (1) of rule 51)

Name of the

Establishment

Name of the

Employer

Name of the Owner

PAN/TAN of the

Employer

Registration
Number of the
establishment
(Labour
Identification
Number (LIN) shall
be
the Registration
Number of the
Establishment)

Sr. No. Nam De De Duration of       Wage Total no. of Total overtime Rate of

in      e sig part Payment of wages Perio days           hours worked or wages

Sl Employ of nati me (Monthly/          d worked             overtime             B D All
.           the on nt Fortnightly/Weekly From- during the
N   ee                                                       production in case as A ow

o. Registe empl         / Daily/Piece rated) To wage         of piece workers ic anc

r/      oyee                             period                                      es

Employ

Code

(1) (2) (3) (4) (5)     (6)             (7)         (8)               (9)         (1 (1 (12)

0) 1)

Amount of wages                                   Deductions                  Net

earned                                                                  Paymen

Bas DA All Ove Total EPF ESI Soc Inc Insu Adv Reco Recovery Tota Oth t
ic ow rtim wages        C iety om ranc ance very on                        l ers

anc e earned             e e s of account Ded

es                       Tax       Fine of uctio

Damages/ ns

Losses

(13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) (24)  (25)      (26) (27) (28)

Date of Receipt by         Nature of acts  Amount Damage or loss Signature of
Payment employee/Bank      and omissions
for which fine  of fine caused to the Employer/Employer
transaction ID  imposed with
date            imposed employer by Representative*

(30)           neglect or default

of the employee

(28)  (29)                                 (31)             (32)     (33)

*Note: Required in case register is maintained physically.