Maternity Benefit (Mines and Circus) Rules, 1961 - Form F

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[See rule 5(3)]



……(name of 1[mine or circus]). I,…., the undersigned, a woman employee/the nominee of….. woman employee/legal representative of…… woman employee deceased in……(name of 1[mine or circus]) at…… in…… district received maternity benefit and/or other amount due under the Maternity Benefit Act, 1961, from the employer of 1[mine or circus] referred to above, as detailed below:-

Rs…… being the first instalment of maternity benefit paid on…….
Rs…… being the second instalment of maternity benefit after delivery paid on……
Rs…… being the medical bonus under section 8 of the Act paid on…….
Rs……being the wages for the leave period from……to…… mentioned under 2[section 9, 9A or 10].

*My/Her confinement/miscarriage 3[Medical termination of pregnancy or tubectomy operation] took place on…….or I/she fell ill because of pregnancy, delivery, premature birth of a child or miscarriage 1[Medical termination of pregnancy or tubectomy operation] on. In consequence I,…… her nominee/legal representative have received the aforesaid amounts prescribed in 2[sections 5,8,9, 9A and 10] of the Maternity Benefit Act, 1961.

Signature or thumb impression of……..

*Woman employee or her nominee or legal representative

             Signature of an Attestor in case the woman is
               not able to sign and affixes thumb impression


*Strike out unnecessary portion.





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bobbyhelp, India

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

vijaya54, India

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.

binay26061978, India

is maternity act applicable to construction industry

HRDExe, India

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

marchall, United States

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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