Form XVI — Wage Slip

Rule: Rule 72(2) · Signed by: Manager · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Date of issue
• Name of the Establishment
• Address
• Period
• Name of the Employee
• Father's/Mother's/Spouse's Name
• Designation
• UAN
• Bank Account Number
• Wage period
• Rate of wages payable - a) Basic
• Rate of wages payable - b) D.A.
• Rate of wages payable - c) other allowances
• Total attendance/unit of work done
• Overtime wages
• Gross wages payable
• Total deductions - a) PF
• Total deductions - b) ESI
• Total deductions - c) Others
• Net wages paid
• Employer/Pay-in-charge signature

This page opens the blank statutory form in MedFactory, ready to fill, save and print. See the Form XVI reference page for the rule and signatory detail.

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