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Maternity Benefit Act,1961

FORM N: Details of Payment made During the Year Ending 31st December, 20...

[Rule 16]

Name of person to whom paid Amount paid

1. Date of payment

2. Woman employee

3. Nominee of the woman

4. Legal representative of the woman

5. Amount for the period preceding date of expected delivery

6. Amount for the subsequent period

7. Under section 8 of the Act

8. Under section 9 of the Act

3 [8a. Under section 9A of the Act.]

9. Under section 10 of the Act

10. Number of women workers who absconded after receiving the first installment of maternity benefit

11. Cases where claims were contested in a court of law

12. Results of such cases

13. Remarks

Date ___________ Signature of employer

Maternity Benefit Act, 1961 Back

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