Receipt Of Maternity Benefit


Maternity Benefit Act, 1961


FORM F: Receipt of Maternity Benefit

[Rule 5(3)]

To

___________________ (name of mine or circus).

I, __________, the undersigned, a woman employee/ the nominee of ________ woman employee/ legal representative of woman employee deceased in _______ (name of mine or circus) at _______ in ________ district received maternity benefit and/or other amount due under the Maternity Benefit Act, 1961, from the employer of mine or circus 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 2[section 9, 9A or 10].

*My/ Her confinement/ miscarriage 3[medical termination of pregnancy or tubectomy operation] took place on _______ or I/ she fell ill because of pregnancy, delivery, premature birth of a child or miscarriage 3[medical termination of pregnancy or tubectomy operation] on _____. In consequence I,_____ her nominee/ legal representative have received the aforesaid amounts prescribed in 1[sections 5, 8, 9, 9A and 10] of the Maternity Benefit Act, 1961.

Date ________ Signature or thumb impression of __________

*Woman employee or her nominee or legal representative

Signature of an attester in case the woman is not able to

Date ________ sign and affixes thumb impression

Legal Process Outsourcing This Document

User Comments


×

C2RMTo Know More

Something Awesome Is In The Work

0

DAYS

0

HOURS

0

MINUTES

0

SECONDS

Sign-up and we will notify you of our launch.
We’ll also give some discount for your effort :)

* We won’t use your email for spam, just to notify you of our launch.
×

SAARTHTo Know More

Launching Soon : SAARTH, your complete client, case, practise & document management SAAS application with direct client chat feature.

If you want to know more give us a Call at :+91 98109 29455 or Mail info@soolegal.com