Hi, There is no format. Employee need to submit a request letter to Employer confirming her pregnancy with a request for maternity leave. Doctor certificate confirming the pregnancy to be attached.
From India, Madras
947From India, Madras
Maternity Benefit (Karnataka) Rules
FORM ‘D’
[See Rule 5 (1)]
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment)
I, (name woman) wife/daughter 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/have given birth to a child
on (date) and shall be absent from work form (date) on
I shall not work in any establishment during the period for which I receive maternity benefit.
2. For the purpose of Section 7, I hereby nominate
(here enter name and address of the nominee) to receive maternity benefit and/or any other amount due to me under for the Act in case of my death.
Signature of an attestor in case the
woman is no able to sign and
Signature or thumb-impression
affix thumb-impression of woman.
Date
From India, Bengaluru
FORM ‘D’
[See Rule 5 (1)]
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment)
I, (name woman) wife/daughter 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/have given birth to a child
on (date) and shall be absent from work form (date) on
I shall not work in any establishment during the period for which I receive maternity benefit.
2. For the purpose of Section 7, I hereby nominate
(here enter name and address of the nominee) to receive maternity benefit and/or any other amount due to me under for the Act in case of my death.
Signature of an attestor in case the
woman is no able to sign and
Signature or thumb-impression
affix thumb-impression of woman.
Date
From India, Bengaluru
Maternity Benefit (Karnataka) Rules
FORM ‘D’
[See Rule 5 (1)]
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment)
I, (name woman) wife/daughter 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/have given birth to a child
on (date) and shall be absent from work form (date) on
I shall not work in any establishment during the period for which I receive maternity benefit.
2. For the purpose of Section 7, I hereby nominate
(here enter name and address of the nominee) to receive maternity benefit and/or any other amount due to me under for the Act in case of my death.
Signature of an attestor in case the
woman is not able to sign and
Signature or thumb-impression
affix thumb-impression of woman.
Date
From India, Bengaluru
FORM ‘D’
[See Rule 5 (1)]
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment)
I, (name woman) wife/daughter 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/have given birth to a child
on (date) and shall be absent from work form (date) on
I shall not work in any establishment during the period for which I receive maternity benefit.
2. For the purpose of Section 7, I hereby nominate
(here enter name and address of the nominee) to receive maternity benefit and/or any other amount due to me under for the Act in case of my death.
Signature of an attestor in case the
woman is not able to sign and
Signature or thumb-impression
affix thumb-impression of woman.
Date
From India, Bengaluru
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