Form XX

[See rule 49(3)(a)]

Format for self- assessment of contribution by aggregators of gig workers or platform workers

( to be submitted by 30th June of the current year in which the contribution is payable. )

1 Registration number (LIN) of Aggregator

2 Name of the Aggregator and address/ location of Aggregator

3 Name and address of the authorised person along with contact details

4 Number of gig workers or platform workers engaged with the Aggregator as on opening day of

the current financial year, i.e. 1st day of April in the year in which contribution is payable.

5 Annual turnover of such aggregator of the preceding year

6 Provisional contribution assessment (tick whichever is applicable) -

6.1 % of the annual turnover as notified under sub-section (4) of section 114 for the preceding

year

6.2 5% of amount paid or payable to gig workers and platform workers, by the aggregator during

the preceding year.

7 Amount of contribution payable (in Rs.)

8 Payment of provisional contribution as assessed above.

9 Details of the provisional payment

10 R emarks, if any

Note: For this purpose, the annual turnover of an aggregator shall not include any tax, levy and

cess paid or payable to the Central Government.

Declaration

I/We hereby declare that the particulars given above are true to the best of my/our knowledge and

belief and I/We hereby declare that nothing has been concealed or any fact has been mis-represented

in the above calculation made by me/us.

Signature of authorised person

Along with seal and stamp

Name:

Date:

Place:

Mobile Number:

E-mail (if any):