Maternity Benefit Rules, 1961 - Form A

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(See rule 3)


Name of [mine or circus]

1. Serial Number.
2. Name of woman and her father's (or, if married, husband's) name.
3. Date of appointment.
4. Nature of work.
5. Dates with month and year in which she is employed, laid off and not employed.

No. of



No. of


laid off

No. of

days not



6. Date on which the woman gives notice under section 6.

7. Date of discharge/dismissal, if any.

8. Date of production of proof of pregnancy under section 6.

9. Date of birth of child.

10. Date of production of proof of delivery/miscarriage/ 1[Medical Termination of pregnancy/ tubectomy operation/death.]

11. Date of production of proof of illness referred to in section 10.

12. Date with the amount of maternity benefit paid in advance of expected delivery.

13. Date with the amount of subsequent payment of maternity benefit.

14. Date with the amount of bonus, if paid, under section 8.

15. Date with the amount of wages paid on account of leave under section 9.

2[15A. Date with the amount of wages paid on account of leave under section 9A.]

16. Date with the amount of wages paid on account of leave under section 10 and period of leave granted.

17. Name of the person nominated by the woman under section 6.

18. If the woman dies, the date of her death, the name of the person to whom maternity benefit and/or other amount was paid, the amount thereof, and the date of payment.

19. If the woman dies and the child survives, the name of the person to whom the amount of maternity benefit was paid on behalf of the child and the period for which it was paid.

20. Signature of the employer of 3[the mine or circus] authenticating the entries in the muster-roll.

21. Remarks column for the use of the Inspector.



Subs. by G.S.R. 70(E), dated 31st January, 1996 (w.e.f. 31-1-1996).


Ins. by G.S.R. 70(E), dated 31st January, 1996 (w.e.f. 31-1-1996).


Subs. by G.S.R. 59(E), dated 27th February, 1975 (w.e.f. 1-3-1975).

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Hi all, please help me how to fill the form A document need to help very urgent


Has the Indian Law been amended for maternity leave? can you please provide the section and law details if so. I came to know that the government has mandated a 6 months maternity leave. Please advice.


is maternity act applicable to construction industry


Maternity act is applicable to the certain staff engaged by our establishmenton on contrcatual basis. My question is

whether this benfit is payable to the employee if she does not join after availing the maternity leave for which she is entitled for. And if she resigned from the estblishment after the expiry of the said leave, what will be the date of relieving? the day she last attended the establishment or the date on which the maternity leave ended. Please clarify.

Goswami, Admn Officer


Please help me understand this works with companies that use Recruiting agencies to fulfill contingent labor needs? Are they responsible for paying the contractor maternity leave payout? Or would that be the responsibility of the agency that the work is actually employed by?

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