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
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1015From India, Madras
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Maternity Benefit (Karnataka) Rules
FORM 'D' [See Rule 5 (1)]
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment) I, (woman's name), 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 from (date) on. I shall not work in any establishment during the period for which I receive maternity benefit.
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 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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FORM 'D' [See Rule 5 (1)]
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment) I, (woman's name), 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 from (date) on. I shall not work in any establishment during the period for which I receive maternity benefit.
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 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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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 of 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 from (date).
I shall not work in any establishment during the period for which I receive maternity benefit. 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 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 the woman. Date
From India, Bengaluru
Acknowledge(0)Amend(0)
Notice under Section 6 of the Maternity Benefit Act, 1961
(Name of establishment) I, (name of 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 from (date).
I shall not work in any establishment during the period for which I receive maternity benefit. 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 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 the woman. Date
From India, Bengaluru
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