F   O    R   M  -III    

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(See Rule  21 (4-A)

DEDUCTION   FROM    WAGES

Return for the year ending 31^st December.

 

 

1.            (a)Name of the establishment &

             postal address.

        (b)Name and residential address of the

            owner/contractor.

        (c) Name and residential address of Managing

             Agent/Director/Partner in charge of any day to

             to day affairs of the establishment owned by a

             Company Body Corporation or association.

        (d) Name and residential address of the

              Manager/Agent, if any.

 

2.            No.of days worked during the year

 

3.            No.of mandays worked during the year.

 

4.            Average number of persons employed during the year.

        Adults:_________________(ii)Children:______________

 

5.            Total wages paid in cash ________

 

6.            Total cash value of the wages paid in kind._____________

 

7.                                                                                Deductions                             No.of cases.                 Amount.

        (a)     Fine.

        (b)     Deduction for damage or loss.

        (c)     Deduction for breach of contract.

 

8.            Disbursement from  fines.

 

        (a)

        (b)

        (c)

 

9.            Balance of fund in hand at the end of the year.

 

Place.__________________                                                                     Signature of the Employer.

Date.___________________

 

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