F O R M -III
(See Rule 21 (4-A)
DEDUCTION FROM WAGES
Return for the year ending 31
(a)Name of the establishment &
(b)Name and residential address of the
(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.
No.of days worked during the year
No.of mandays worked during the year.
Average number of persons employed during the year.
Total wages paid in cash ________
Total cash value of the wages paid in kind._____________
Deductions No.of cases. Amount.
Deduction for damage or loss.
Deduction for breach of contract.
Disbursement from fines.
Balance of fund in hand at the end of the year.
Signature of the Employer.