Form XXI

[See rule 49 (3)(b) and (c)]

Format for return to be submitted by Aggregators of gig workers or platform workers

( to be submitted by 31st October, 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 Final contribution assessment after audited statement of account (Amount in

Rs.)

6.1 % of the annual turnover as per notification under sub-section (4) of section

114 for the preceding year

6.2 5% of the liability of the aggregator to gig workers and platform workers

7 Amount of contribution payable (in Rs.)

8 Amount paid as provisional contribution

based on self-assessment.

9 Details of the provisional payment (along with receipt)

10 A mount of outstanding contribution to be paid (Sl. No 7- Sl.No. 8)

11 Proof of payment of outstanding contribution, if any

12 Amount of excess paid contribution, if any

13 In case excess paid, details of the bank account in which excess amount is to be

refunded

14 Remarks, 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):