13 Particulars of Maternity Benefits 1. Total No. of women workers who worked for a period of 160 days in the last 12 months immediately preceding the date of delivery 2. No. of women workers discharged / dismissed in the last 12 months 3. No. of women workers for whom pre-natal confinement and post-natal confinement is provided by the employer with free of cost 4. No. of women workers died Before delivery After delivery Leave / additional leave details: Item No. of Women Leave sanctioned Leave Reject applied for leave Miscarriage Illness (additional leave under section (10) Maternity benefit paid: Item No. of Claims No. of leave No. of claims Total benefit paid in rupees Received sanctioned rejected Confinement Miscarriage Illness Medical Bonus 14. Particulars of deductions made from salary (wages): No. of employees involved Total amount of deduction made Fines Damages/Loss Breach of contract Others Total
13 Particulars of Maternity Benefits 1. Total No. of women workers who worked for a period of 160 days in the last 12 months immediately preceding the date of delivery 2. No. of women workers discharged / dismissed in the last 12 months 3. No. of women workers for whom pre-natal confinement and post-natal confinement is provided by the employer with free of cost 4. No. of women workers died Before delivery After delivery Leave / additional leave details: Item No. of Women applied for leave Leave sanctioned Leave Reject Miscarriage Illness (additional leave under section (10) Maternity benefit paid: Item No. of Claims Received No. of leave sanctioned No. of claims rejected Total benefit paid in rupees Confinement Miscarriage Illness Medical Bonus 14. Particulars of deductions made from salary (wages): No. of employees involved Total amount of deduction made Fines Damages/Loss Breach of contract Others Total
FORM_Rule.docx