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Wednesday, 01 September 2010 05:30

Download Application Form of Receipt of Maternity Benefit

Download forms for state: Andaman and Nicobar Island
Form Details
StateAndaman and Nicobar Island
DepartmentDepartment of labour
TitleApplication Form of Receipt of Maternity Benefit
Document Size12.5 KB
Text of the PDF document(for quick reference)
FORM 'F' [See Rule 5 (3) ] Form of receipt of Maternity Benefit (Name of establishments). The undersigned, a woman*employee/the nominee of Woman employee/legal representative of Woman employee deceased in (name of Establishment) at in District received maternity benefit and/or other amount due under the Maternity Benefit Act, 1961, from the employer of the establishment referred to above, as detailed below:- Rs. being the first installment of maternity benefit paid on............ Rs. being the Second installment of maternity benefit after............ delivery paid on Rs. being the medical bonus under Section 8 of the Act paid on.......... Rs. being the wages for the leave period from.......to......mentioned Under Sec. 9 or 10. *My/Her confinement/miscarriage took place on or I/She fell ill because of pregnancy, delivery, premature birth of child a miscarriage on ....... in consequence I her nominee/legal representative have received that aforesaid amounts prescribed in Section 5,8,9 and 10 of the Maternity Benefit Act, 1961. Signature or thumb impression of *Women employee or her nominee or legal representative, Signature of an attester in case the woman is not able to sign and affixes thumb impression. Date........... Strike out unnecessary portion.
Last Updated on Friday, 17 December 2010 05:30

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