📍 When to use this template
- Before processing any RA Bill or Final Bill payment for a contractor or sub-contractor.
- Submitted monthly by the contractor along with their invoice/bill.
- Filled by the Contractor's representative, then verified and countersigned by the PMC/Client's HR/Compliance Officer.
Sections & fields
Preview of the template structure. Download Excel to fill on site.
1Header / Project Information6 fields
Project Name
_____________
Contract / Package No.
_____________
Document No.
_____________
Certification Date
_____________
Prepared By (Contractor)
_____________
Verified By (PMC/Client)
_____________
2Contractor & Bill Details6 fields
Contractor Name
_____________
Work Order / LOA No.
_____________
RA Bill / Invoice No.
_____________
Bill Period (From/To)
_____________
Bill Amount (Gross)
_____________
Certified Amount for Payment
_____________
3Wage & Salary Compliance6 fields
Wage Register Submitted (Yes/No/NA)
_____________
Wage Period Covered
_____________
Proof of Bank Transfer / Acquittance Roll Submitted
_____________
Minimum Wages Act Compliance Verified
_____________
Overtime Register Submitted & Verified
_____________
Bonus / Ex-gratia Paid (if applicable)
_____________
4PF & ESI Compliance (Statutory Deductions)7 fields
PF Registration No.
_____________
PF Challan Submitted for the Period (Yes/No)
_____________
PF Amount Deposited
_____________
ESI Registration No.
_____________
ESI Challan Submitted for the Period (Yes/No)
_____________
ESI Amount Deposited
_____________
ECR (Electronic Challan cum Return) Copy Attached
_____________
5BOCW & Labour Welfare Compliance6 fields
BOCW Registration No.
_____________
BOCW Cess Deducted from Bill (Yes/No)
_____________
Labour Welfare Fund Contribution Challan Submitted
_____________
Number of Workers Registered under BOCW Board
_____________
Health & Safety Compliance Verified (as per BOCW Act)
_____________
6Contract Labour (R&A) Act Compliance6 fields
Valid Labour License No.
_____________
License Validity Date
_____________
Number of Workmen Deployed as per Form XIII
_____________
Form VI-B (Notice of Commencement) Submitted
_____________
Form XIII (Register of Workmen) Maintained & Submitted
_____________
Form XXIV (Half-Yearly Return) Submitted (if applicable)
_____________
7Certification & Approval6 fields
Undertaking by Contractor (Confirming all dues are cleared)
_____________
Name & Signature of Contractor's Authorised Signatory
_____________
Company Seal
_____________
Verification by PMC/Client Compliance Officer
_____________
Remarks / Discrepancies Noted
_____________
Final Approval for Payment Release (Yes/No)
_____________
💡 Sample filled excerpt
Contractor: ABC Infra Pvt. Ltd. | RA Bill No.: RA-05 for April 2024 | PF Challan Submitted: Yes, for March 2024, Amount: ₹85,400 | ESI Challan Submitted: Yes, for March 2024, Amount: ₹32,150 | Remarks: All compliances verified. Payment may be processed.
⚖ Compliance notes
- Fulfills the Principal Employer's responsibility under Section 21 of the Contract Labour (R&A) Act, 1970 to ensure wage payment.
- Provides documentary evidence for audits related to EPF & MP Act, 1952 and ESI Act, 1948, ensuring timely deposit of contributions.
- Ensures compliance with BOCW Act, 1996 regarding cess deduction and worker registration before releasing contractor payments.
- Acts as a key internal control document to prevent statutory liabilities from being passed on to the Principal Employer/Client.