[See rule 16]
DETAILS OF PAYMENT MADE DURING THE YEAR ENDING 31ST DECEMBER,
Name of person to whom paid Amount paid
1. Date of payment.
2. Woman employee.
3. Nominee of the woman.
4. Legal representative of the woman.
5. Amount for the period preceding date of expected delivery.
6. Amount for the subsequent period.
7. Under section 8 of the Act.
8. Under section 9 of the Act.
1[8a.Under section 9A of the Act.]
9. Under section 10 of the Act.
10. Number of women workers who absconded after receiving the first instalment of maternity benefit.
11. Cases where claims were contested in a court of law.
12. Results of such cases.
Signature of employer
Ins. by G.S.R. 70(E), dated 31st January, 1996 w.e.f. 31-1-1996).