FORM XXI
[SEE RULE 52 (2) (C)]
REGISTER OF DEDUCTION FOR DAMAGE OR LOSS

Name and address of Contractor.
Nature and location of work.
Name and address of establishment in/under which inter-State migrant workmen are employed.
Name and address of Principal Employer.
1. Serial number
2. Name of inter-state migrant workman
3. Father’s/Husband’s name
4. Nature of Employment/Designation
5. Wage period and wages payable
6. Date and amount of advance given
7. Purpose(s) for which advance made
8. Number of instalments by which advance to be repaid
9. Date and amount of each installment repaid
10. Date on which last installment was repaid
11. Remarks