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Form E

This document is a notice under the Maternity Benefit Act, 1961, where an employee informs their employer of their expected confinement or recent childbirth. It includes a nomination for an individual to receive maternity benefits on behalf of the employee in case of their death. The document requires signatures from both the employee and an attester if the employee cannot sign themselves.

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467 views1 page

Form E

This document is a notice under the Maternity Benefit Act, 1961, where an employee informs their employer of their expected confinement or recent childbirth. It includes a nomination for an individual to receive maternity benefits on behalf of the employee in case of their death. The document requires signatures from both the employee and an attester if the employee cannot sign themselves.

Uploaded by

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

[See rule 5(1)]


NOTICE UNDER SECTION 6 OF THE MATERNITY BENEFIT ACT, 1961

To,

I ___________________________________________________________________________________

wife/daughter of ______________________________________________________________________

employed as _________________________________________________________________________

at __________________________________________________________________________________

hereby give notice that

1) I expect to be confined within six weeks next following from the date of this notice/have given

birth to a child on __________ and shall be absent from work from _________________. I shall

not work in any establishment during the period for which I receive maternity benefit.

2) For the purpose of Section 7, I hereby nominate _______________________________________

to receive maternity benefit and/or any other amount due to me under the Act in case of my

death.

Signature of an Attester in case the employee Signature or impression of the employee


is not able to sign and affix thumb impression.

Date:

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