Form V
Wage slip · see rule 52 · Code on Wages, 2019, section 50(3)
Central rules notified as G.S.R. 343(E), 8 May 2026.
State-governed establishments: use your state's form.
State-governed establishments: use your state's form.
Date of issue31/10/2026
Name of the EstablishmentKaveri Agencies
AddressNo. 14, Sayyaji Rao Road, Mysuru, Karnataka 570001
Period01/10/2026 – 31/10/2026
| No. | Particulars | Details |
|---|---|---|
| 1. | Name of employee | Ravi Kumar |
| 2. | Father's/Mother's/Spouse Name | Suresh Kumar |
| 3. | Designation | Store assistant |
| 4. | UAN | 1000 0000 0000 |
| 5. | Bank Account Number | XXXXXXXX4521 |
| 6. | Wage period | Monthly, 01/10/2026 – 31/10/2026 |
| 7. | Rate of wages payable | |
| a. | Basic | ₹15,000 |
| b. | DA | ₹3,000 |
| c. | Allowances | ₹4,000 |
| 8. | Total attendance/unit of work done | 26 days |
| 9. | Overtime wages | ₹1,200 |
| 10. | Gross wages payable | ₹23,200 |
| 11. | Total deductions | ₹2,360 |
| a. | PF | ₹2,160 |
| b. | ESI | ₹0 |
| c. | Others (professional tax) | ₹200 |
| 12. | Net wages paid | ₹20,840 |
Net wages in wordsRupees twenty thousand eight hundred forty only
Issue on or before the day wages are paid, on paper or electronically.
Note: signature required in case register is maintained physically.
Note: signature required in case register is maintained physically.
*Employer / Pay-in-charge signature
Kaveri Agencies
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