[See rule 4(1)]
This is to certify that I examined…. wife /daughter of ….. a woman employee in…… (name of 1[mine or circus]) on…... (date) 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/ [Medical termination of pregnancy or tubectomy 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 ].
Signature, qualifications and designation of
Medical Officer/Medical Practitioner.
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.
Ins. by G.S.R. 70(E), dated 31st January, 1996 (w.e.f. 31-1-1996).