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Dhampur Sugar Mill Ltd.Dhampur

Full & Final Payment Statement
SAP/Emp.Code Category
Name of Employee Nature
Father's Name Date Of Joining
Designation Date Of Leaving
Department Reason of Leaving

(A) PAYMENTS
PRESENT SALARY
Month Days=> 30 Unpaid Days=>
Payment against
Payment against
COMPONANT (INR) Per Month Previous Month's, if Total Amount Remarks
Current Month
any
Basic Salary - -
Variable Dearness Allowance (VDA) - -
Fixed Allowance (FA) - -
House Rent Allowance (HRA) / Kiraya - -
Children Education Allowance - -
Tansport Allowance - -
Composit Allowance - -
Medical Allowance - -
*Leave Travel Assistance - - -
*Bonus @8.33% - - -
*Leave Encashment - - -
Total - - - -
Total (Per Annum) - Total (A), Rounded Off -
(B) PAYABLE AGAINST UNPAID OR OTHER PAYMENTS
COMPONANT (INR) Perioid / Days Amount Remarks
Leave Travel Assistance (LTA) from______________ to_____________ -
Bonus from______________ to_____________ @______% -
Leave Encashment Days _______
Incentive (if any) from______________ to_____________
Gratuity, if applicable from______________ to_____________
Retaining, if applicable from______________ to_____________
Notice Pay (if any) Days _______
Any Other as Specified Below:-

Total (B), Rounded Off -

(C) DEDUCTIONS
Deduction against
Deduction against
COMPONANT (INR) Previous Month's, if Total Amount Remarks
Current Month
any
PF @12% 0 -
VPF -
Income Tax -
Mobile Usage -
GH /Canteen Charges -
Vehicle Usage Charges -
Sports Complex Charges -
Club Charges -
House Maintenance Charges -
Cable Connection Charge -
LIC Payment -
Salary Advance -
Notice Pay Recovery -
GST on Notice Pay @ 18% 0 -
Any Other as Specified Below:- -
-
-
Total (C) - - -
Net Payble / Recoverable Amt (A + B - C) -
Amount Received from Employee (if any)
Amount On Hold
Payment Made / to be Recovered -
* Note (if any):

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Calculation of Bonus Calculation of LTA

Month Rate Pay Days Payable Amt Month Rate Pay Days Payable Amt
Apr 7000 - Apr -
May 7000 - May -
Jun 7000 - Jun -
Jul 7000 - Jul -
Aug 7000 - Aug -
Sep 7000 - Sep -
Oct 7000 - Oct -
Nov 7000 - Nov -
Dec 7000 - Dec -
Jan 7000 - Jan -
Feb 7000 - Feb -
Mar 7000 - Mar -
Total - Total -

Prepared by Checked by Page 2 of 2 Approved by