FORM ‘N’ (See Rule 16) Details of payment made during the year ending 31st. December, 19___. Name of persons to whom paid 1. Date of payment. 2. Woman employee. 3. Nominee of women. 4. Legal representative of woman. 5. Amount for the period preceding dates of expected delivery. 6. Amount for the subsequent period. 7. Under Section 8 of the Act. 8. Under Section 9 of the Act. 9. Under Section 10 of the Act. 10. Number of women workers who absconded after receiving the first installment of maternity benefit. 11. Cases where claims were contested in a Court of law. 12. Results of such cases. 13. Remarks. Signature of the Employer, Dated _____________
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