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For the period ________________________ to ______________________ 20_____.
(Which may not exceed one month)
Name in full: __________________________________________________
Identity number of employee: _____________________________________
Occupation (full time/regular day worker/gardener, etc.): ________________
Age, if under 21, otherwise adult : __________________________________
Ordinary wage per hour, day week or month : ________________________
Value of payment in kind: ________________________________________
Total ordinary hours worked: _____________________________________
Amount due for ordinary hours worked R __________
Overtime (state day of the week and hours or fractions thereof): __________
Total overtime for week (hours): ___________________________________
Amount due for overtime (payment in kind included) R _________
Hours worked on Sundays or public holidays : ________________________
Amount due for work on Sundays or public holidays R __________
(including payment in kind)
Amount due in respect of any allowances R __________
Amount deductions R __________
Total amount due R __________
An employee's wage includes the value of payment in kind, where the employer provides food, accommodation and any other payment other than cash or an amount agreed to in writing by the parties, whichever is the larger.
The employer must keep these records for a period of not less than three years after the date of the last entry therein or thereon.
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