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Employees’ State Insurance (General) Regulations, 1950

FORM 24: Maternity Benefit

[Regulation 91]


    I,___________ ,wife/daughter of ___________ Insurance No _________________ do hereby give notice that I have taken/ shall take up work for remuneration from ____________________

    I have drawn maternity benefit only up to ______________________

Date ____________________

Present address  (if changed)____________

Signature or thumb-impression

Local office ____________

Employees'   State Insurance (General) Regulations, 1950 Back

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