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Wage Slip
(Form V under rule 52 of the Code on Wages (Central) Rules, 2026 and section 50(3) of the Code on Wages, 2019)
Date of issue [DATE OF ISSUE]
Name of the establishment [ESTABLISHMENT NAME]
Address [ESTABLISHMENT ADDRESS]
Period [MONTH AND YEAR]
No. Item Details
1 Name of employee [EMPLOYEE NAME]
2 Father's / Mother's / Spouse's name [PARENT OR SPOUSE NAME]
3 Designation [DESIGNATION]
4 UAN [UAN]
5 Bank account number [BANK ACCOUNT NUMBER]
6 Wage period [ ] daily [ ] weekly [ ] fortnightly [ ] monthly — from [START DATE] to [END DATE]
7 Rate of wages payable a. Basic: ₹[BASIC] b. DA: ₹[DA] c. Allowances: ₹[ALLOWANCES] ([NAMES OF ALLOWANCES])
8 Total attendance / unit of work done [DAYS PRESENT] days of [WORKING DAYS] / [UNITS OF WORK]
9 Overtime wages (at least twice the normal rate) [OVERTIME HOURS] hours × ₹[OVERTIME RATE] = ₹[OVERTIME WAGES]
10 Gross wages payable ₹[GROSS WAGES]
11 Total deductions a. PF: ₹[PF] b. ESI: ₹[ESI] c. Others: ₹[OTHER DEDUCTIONS] ([PURPOSE, E.G. ADVANCE, TDS, PROFESSIONAL TAX]) — total ₹[TOTAL DEDUCTIONS]
12 Net wages paid ₹[NET WAGES] ([NET WAGES IN WORDS])
Date of payment: [DATE OF PAYMENT] Mode: [ ] bank transfer [ ] electronic [ ] cheque [ ] cash
Employer / pay-in-charge signature: ____________________ Name: [NAME OF SIGNATORY]
(required where the register is maintained on paper)
Employee's acknowledgement (optional)
I have received this wage slip and the net wages shown above.
Name: [EMPLOYEE NAME] Date: [DATE] Signature: ____________________
For me: before giving the slip
[ ] Given on or before payday, by email or on paper (rule 52)
[ ] Monthly wages paid before the end of the 7th day of the next month (section 17(1)(iv)); final wages within two working days of resignation, dismissal, retrenchment or closure (section 17(2))
[ ] Every deduction is for a purpose listed in section 18(2), and the total is not more than 50 % of the wages (section 18(3))
[ ] Overtime paid at not less than twice the normal rate (section 14)
[ ] Not a central-sphere establishment? Check whether your State rules prescribe their own wage slip form
[ ] Wage register kept electronically or on paper and preserved for five years after the last entry (rule 51(4))