Form XX — Register for Leave with Wages

Rule: Rule 76 · Signed by: Manager · Under: OSH & Working Conditions (Central) Rules 2026

What the form records

• Sl. No
• Sl.no. in the register of workers
• Date of entry into service
• Interruptions - Sickness and accidents
• Interruptions - Authorised Leave
• Interruptions - Lock Out or Legal Strike
• Interruptions - Involuntary unemployment
• Interruptions - Others
• Leave due with effect from
• Whether leave not desired during the next 12 months
• Date from which the worker is allowed leave
• Wages for Leave Paid in
• Discharged worker - Date of Discharge
• Discharged worker - Date and amount of payment made in lieu of leave due
• Leave - Accumulated carry forward leave
• Remarks

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

MedFactory — Occupational Health Centre software for Indian factories