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Employees' State Insurance (General) Regulations, 1950

FORM 19: Maternity Benefit

[Regulation 87]

NOTICE OF PREGNANCY

    I,____________ Insurance No ____________ wife/daughter of ____________ ,hereby give notice of pregnancy.

Present address________________________

Present / last employee

Date ___________________

Signature or thumb impression





Employees'   State Insurance (General) Regulations, 1950 Back






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