{{ strtoupper($form ?? 'Form B') }}

(See Rule 29 of the Tamil Nadu Labour Welfare Fund Rules,1973)

Name and full address of the Establishment: {{ $report['establishment_name'] ?? '' }}

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Name of the Employer/ Contractor / Managing Director: {{ $report['employer_name'] ?? '' }}

Managing Partner or Authorized Person with full Residential address: {{ $report['address'] ?? '' }}

Total No. of Employees	Total emoluments payable during the month including Basic Wages,D.A.,O.T., and Bonus	Amounts deducted during the month		Amount Actually paid during the month	Balance due to the employees
		Fine (a)	Other Dedu (b)
73	1493938.28	0	212201.71	1281736.57	0.00

Place: Chennai

Date: 31/05/2025

Signature of Employer/Manager