OSH Code · Form XVI
Form XVI — Wage Slip
Form XVI of the OSH & Working Conditions (Central) Rules 2026, prescribed under Rule 72(2).
Rule: Rule 72(2) · Signed by: Manager
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
Part of the Seventh Schedule to the OSH & Working Conditions (Central) Rules 2026. View the official form layout in the gazette, or open the OSH Code forms in MedFactory.
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