Home>>Select the State>>Select department within Andaman and Nicobar Island>>Select forms to download>>This Page
Follow us on: FacebookTwitter

Google +1 Button

Wednesday, 01 September 2010 05:30

Download Application for Complaint Arising out of Non-Payment of Maternity Benefit, Medical Bonus etc.

Download forms for state: Andaman and Nicobar Island
Form Details
StateAndaman and Nicobar Island
DepartmentDepartment of labour
TitleApplication for Complaint Arising out of Non-Payment of Maternity Benefit, Medical Bonus etc.
Document Size16.5 KB
Text of the PDF document(for quick reference)
FORM 'I' (See Rule 10) To The Inspector, (Under the Maternity Benefit Act, 1961) I, (name), a person nominated under Sec. 6 by or a legal representative of .... ......(name of woman) employed in .....(name and full address of establishment) have to complain that the said woman having fulfilled the conditions laid down in the Maternity Benefit Act, 1961 and the rules there under is entitled to Rs. being maternity benefit and/ or Rs. being the medical bonus and/or Rs. being wages for leave due under Sec. 9 or 10 but the same has been improperly with-held by the employer. He may, therefore, be directed to pay the amount to me. Signature or thumb impression of the nominee/legal representative. Signature of an attester in case the nominee/legal representative is unable to sign. and affixes thumb impression. Full address of the nominee/legal representative.
Last Updated on Friday, 17 December 2010 05:30

Add comment

Security code

We don't keep copyrighted documents. Only free and public documents are allowed at this site

Copyright © 2022 Download Forms India. All Rights Reserved.