F O R M -III (See Rule 21 (4-A) DEDUCTION FROM WAGES Return for the year ending 31st 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 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 man days 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.
