Notice of claim for maternity benefit and payment thereof under sections 62 and 63

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.... of...... employed as...... at.........(name of establishment), hereby give notice that I expect to be confined within six weeks next following from the date of this notice or have given birth to a child on.....(date) and shall be absent from work from.....(date). I shall not work in any establishment during the period for which I receive maternity benefit. 2. For the purpose of section 63, I h....

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.... Rs...... being the first installment of maternity benefit paid on...... Rs...... being the second installment of maternity benefit after delivery paid on...... Rs...... being the medical bonus under section 64 of the Code paid on...... Rs......being the wages for the leave period from...... to...... mentioned under section 65. *My/Her confinement/miscarria....