FORM ‘M’
(See Rule 16)
Employment, dismissal, payment of hours, etc., of woman for the year ending 31st.
December, 19 ___.
1. Establishment.
2. Aggregate number of woman permanently or temporarily employed during the
year.
3. Number of women who worked for a period of not less than one hundred and
sixty days in the twelve months.
4. Number of women who gave notice under Section 6.
5. Number of women who were granted permission to absent on receipt of notice of
confinement.
6. Number of claims for maternity benefit paid.
7. Number of claims for maternity benefit rejected.
8. Number of cases where prenatal, confinement and post-natal care was provided
by the management free of charge (section 8).
9. Number of claims for medical bonus paid (Section 8).
10. Number of claims for medical bonus rejected.
11. Number of cases in which leave for miscarriage was granted.
12. Number of cases in which leave for miscarriage was applied for but was rejected.
13. Number of cases in which additional leave for illness under Section 10 was
granted.
14. Number of cases in which additional leave for illness under Section 10 was
applied for but was rejected.
15. Number of women who died:
(a) before delivery.
(b) after delivery.
16. Number of cases in which payment was made to persons other than the woman
concerned.
17. Number of women discharged or dismissed while working.
18. Number of women deprived of maternity benefit and/or medical bonus under
proviso to sub-section (2) of Section 12.
19. Number of cases in which payment was made on the order of the Competent
Authority or Inspector.
20. Remarks.
N.B. -- Full particulars of each case and reason for the action taken under Serial Nos.
7,10,14,17 and 18 should be given in the Appendix below-
Signature of employer,
Date___________
| 