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(See Rule 4) The Maternity Benefit Rules, 1961: Form B

This document is a Form B medical certificate under the Maternity Benefit Rules, 1961. The form is to be completed by a medical officer or practitioner to certify whether a woman employee is pregnant, expected delivery date, has undergone miscarriage, medical termination of pregnancy, tubectomy operation, or is suffering from illness arising from pregnancy, delivery, or miscarriage. The certificate requires information on the woman employee and medical officer as well as the examination date and findings. Definitions of "child" and "miscarriage" are also provided under the Maternity Benefit Act, 1961.

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Abhishek Mishra
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7K views1 page

(See Rule 4) The Maternity Benefit Rules, 1961: Form B

This document is a Form B medical certificate under the Maternity Benefit Rules, 1961. The form is to be completed by a medical officer or practitioner to certify whether a woman employee is pregnant, expected delivery date, has undergone miscarriage, medical termination of pregnancy, tubectomy operation, or is suffering from illness arising from pregnancy, delivery, or miscarriage. The certificate requires information on the woman employee and medical officer as well as the examination date and findings. Definitions of "child" and "miscarriage" are also provided under the Maternity Benefit Act, 1961.

Uploaded by

Abhishek Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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FORM B

[See rule 4]

The Maternity Benefit Rules, 1961

This is to certify that I examined_______________________________ wife /

daughter of __________________________________ a woman employee

in__________________________________________ (name of l[mine or circus])

on_________________ (date-DD/MM/YYYY) and found / cannot discover that

she is pregnant and is expected to be delivered of a child

within__________________ (month and & days) from the above mentioned

date / has undergone miscarriage /1[Medical termination of pregnancy or tube to

my operation] / has been delivered of a child

on_______________________(date) or is suffering

from____________________(date) from illness arising out of pregnancy/delivery

/ premature birth of a child or miscarriage / 1[Medical termination of pregnancy or

tubectomy operation ].

Seal
Signature of the Medical Officer / Medical Practitioner

Qualifications and Designation


.
Registration No.
Date:_________________

Definitions of "child" and "miscarriage" as in the Maternity Benefit Act, 1961.-

1. "Child" includes a still-born child.

2. "Miscarriage" means expulsion of the contents of a pregnant uterus at any period prior to or
during the twenty-sixth week of pregnancy but does not include any miscarriage, the causing
of which is punishable under the Indian Penal Code.
Rule 4. - Proof.-(1) The fact that a woman is pregnant or has been delivered of a child 7[or has undergone miscarriage or medical
termination of pregnancy or tubectomy operation or is suffering from illness arising out of pregnancy, delivery, premature birth of a child or
miscarriage or medical termination of pregnancy or tubectomy operation] shall be proved by the production of a certificate to that effect,- (c)
from a Registered Medical Practitioner.

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