FORM XVI
(See rule 51 (1)]
Return Journey Allowance Register
           
Name and address of the Contractor.
Name and address of the Principal Employer.
Name and address of the establishment.
Month and Year.
1. Serial No.
2. Name of the migrant workman
3. Father’s/Husband’s name
4. Permanent home address indicating the State
5. Place and address of residence in home State
6. Designation
7. Rate of wages
8. Place of work
9. Railway Station/Bus Stand nearest to the place of work
10. Railway Station/Bus Stand nearest to the place of residence in the home State
11. Date and time of commencement of journey from the place of work
12. Expected date and time of arrival at the residence in the home State.
13. *Expected of modes of journeys from the place of work to place of residence in the home State.
14. Amount of bus fare and/or second-class train fare and/or other journey expenses separately as per expected modes of journey indicated in column (13)
15. Total of amount indicated in column No. (14)
16. Amount of return journey allowance
17. Wages for return journey period
18. Total amount paid.
19. Date on which paid.
20. Signature or thumb-impression of the migrant workman
21. Remarks
* Indicate separately different modes of journey.
NOTE. -Entries are to be made against each individual inter-State migrant workman.
Signature of the Contractor or his
authorised representative.
Date: