FORM N
[Rule 16]
DETAILS OF PAYMENT MADE DURING THE YEAR ENDING 31ST DECEMBER, 19...

Name of person to whom paid Amount paid
1. Date of payment
2. Woman employee
3. Nominee of the woman
4. Legal representative of the woman
5. Amount for the period preceding date of expected delivery
6. Amount for the subsequent period
7. Under section 8 of the Act
8. Under section 9 of the Act
3[8a. Under section 9A of the Act.]
 9. Under section 10 of the Act
10. Number of women workers who absconded after receiving the first instalment of maternity benefit
11. Cases where claims were contested in a court of law
12. Results of such cases
13. Remarks
Date ___________ Signature of employer
3. Inserted by GSR 70(E), dated 31st. January, 1996, w.e.f.1st. February, 1996.