ANNUAL RETURN — FACTORY
Furnished by the occupier/manager under the Factories Act, 1948 and the relevant State Factories Rules for the calendar year ending 31 December.
Name of Factory: [Company Name] Registration / Licence No.: [__________]
Full Postal Address: [Address] Nature of Manufacturing Process: [Process]
Name of Occupier: [Name] Name of Manager: [Name] Year: [YYYY]
| Particulars | Male | Female | Adolescent / Young | Total |
|---|---|---|---|---|
| Average number of workers employed daily | [___] | [___] | [___] | [___] |
| Total number of workers on roll | [___] | [___] | [___] | [___] |
| Total man-days worked during the year | [___] | [___] | [___] | [___] |
| Item | Details |
|---|---|
| Number of days worked in the year | [___] |
| Leave with wages availed / balance | [___] |
| Number of accidents (fatal / non-fatal) | [___] / [___] |
| Welfare facilities (canteen, crèche, first-aid, restroom) | [Provided / Not applicable] |
| Compensation paid for accidents (₹) | [Amount] |
Certified that the particulars given above are true to the best of my knowledge and belief.
Place: [Place] Date: [DD/MM/YYYY] _______________________
Signature of Occupier / Manager
Compliance note: The annual return (commonly Form 21) must be submitted to the Inspector of Factories, usually by 15th/31st January of the following year (varies by State). A half-yearly return may also be required. Maintain the muster roll, leave register and accident register in support.