Annual Return
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....mation: SI. No. Instructions for filling the column 1. Labour Identification Number EPFO, ESIC, MCA, MOLE (LIN) 2. Period of the Return From - To- Period should be calendar year 3. Name of the Establishment 4. Email ID (employer) 5. Telephone No. (employer) 6. Mobile number (employer) 7. Premise name 8. Sub-locality 9. District 10 . State 11 . Pin Code 12 . Geo Co-ordinates B(a). Hours of Work in a day B(b). Number of Shifts Number of hours in a shift C. Details of Manpower Deployed Details Directly employed Employed through Contractor Grand Total Skill Category Highly Skilled Skilled Semi-Skilled Un-Skilled Highly Skilled Skilled Semi- Skilled Un-Skilled (i) Maximum No. day during the year M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T M/F/T ....
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....ical Practitioner appointed. There is no specification for minimum number of Qualified Medical Practitioner employed in establishment. However, this detail is required to have data on occupational health. F. The Industrial Relations: Instructions for filling 1. Is the Works Committee has been functioning.(Section 3 of IR Code, 2020) Yes/No and not applicable Industrial establishment in which 100 or more workers are employed (a) Date of its constitution. 2. Whether the Safety Redressal Committee constituted (Section 4 of IR Code, 2020) Yes/No and not applicable Industrial establishment employing 20 or more workers 3. Number of registered Unions in the establishments. 4. Whether any negotiation union exist(Section 14 of IR Code, 2020) Yes/No 5. Whether any negotiating council is constituted (Section 14 of IR Code, 2020) Yes/No 6. Number of workers discharged/dismissed, retrenched or whose services were terminated during the year: Dismissed Retrenched Discharged /Terminated or Removed Grand Total 7. M....
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.... Coal/Metal/Oil 6. Name of Mineral 7. Type of Mine (drop down) Belowground/ Opencast/ Aboveground/Mixed/OffShore/OnShore 8. Date of opening To be filled for first time 9 Mine Code To be filled for first time 10. Date of closing (if any) NA/ Calendar to be given 11. Date of reopening (if any) NA/ Calendar to be given 12. Depth of working in mts. Maximum Depth: Minimum Depth: B. Statutory personnel employed in the mine (as on 31st December) SI. No. Designation as per Code Number of Statutory Persons required Number of Statutory Persons employed 1. C. Method of Working vis-a-vis Safety Parameters 1 Name of Method (Specify the name) (as per drop down menu) 2 Quantity of mineral Produced in Cu.m./Tonne 3 Quantity of Waste/overburden removed in Cu.m./Tonne 4 Stage of Working (as per drop down menu) Development/Extraction/Mixed ....
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.... including contractual workers: Particulars Total No. of Persons Imparted Basic Vocational Training Imparted Refresher Training Imparted special Training F. Details of Accident, Dangerous Occurrence and Occupational Diseases : (1) Details of Accidents and Dangerous Occurrences: Sl. No. Date of Accidents/Dangerous Occurrences No. of persons killed No. of persons received Serious Bodily Injury Number of persons injured (Excluding Serious Bodily Injury) and thereby prevented from working for a period of 48 hours or more Nature of Occurrence Mandays lost 1 (2) Details of Occupational diseases: SI. No Notified Disease No. of cases 1 G. Details of Safety Management Plan: (a) Safety Management Plan Prepared: (Yes/No/NA) (b) Date of Submission : Date (c) Last date of review of Safety Management Plan: Date (d) Principal Hazards Identified: Sl. no. List of Principal hazards identified Principal hazard Mitigation date Principal hazard not mitigated till 31st Decem....
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.... .: Sl. Month Name and address of the contractors LIN of the contract or Name of the work Maximum number of contract labour employed Amount paid against wage bill (if applicable) to the contractor (including EPF, ESIC, Bonus etc.) Date of payment of wage bill (if applicable) Amount of the wages paid directly to the contract labour by Principal Employer (in case the contract or fails to pay) Date of payment of wages paid directly to the contract labour by Principal Employer (in case the contract or fails to pay) Remarks Signature of the principal employer Date: PART IV Shram Shuvidha Portal Ministry of Labour and Employment Self-Declaration form for EPFO/ESIC Contribution Year:___ PAN No: LIN:(Auto-Populated) EPF Code No. (Auto-Populated)(E....
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.... * Upload Salary sheet of contribution details of all members as per Form-VIIIB(Register of Wages, Overtime & Dedcution) Details of Employees non-enrolled but eligible to be member: Sr. No Name of Employee Gender Aadhaar Number Father's Name Date of Birth Date of Joining Date of Exit (If already left) Wages paid Contractors details: S.No. Name & Address of the contractor EPF code No. ESI code No. Nature of work Maximum Number of employees employed during any day Total payment made during the FY <* contractor details may be pre-filled from CLC Licence data if available w....
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