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MB Act Form A Duplicate-1

The document is a Muster Roll form under the Maternity Benefit Act 1961 for the establishment Bimarala Bauxite Mines, detailing information about women employees and their maternity benefits. It includes sections for recording personal details, employment status, maternity leave, proof of pregnancy and delivery, and payments made. The form also requires signatures and remarks for inspection purposes.

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79 views1 page

MB Act Form A Duplicate-1

The document is a Muster Roll form under the Maternity Benefit Act 1961 for the establishment Bimarala Bauxite Mines, detailing information about women employees and their maternity benefits. It includes sections for recording personal details, employment status, maternity leave, proof of pregnancy and delivery, and payments made. The form also requires signatures and remarks for inspection purposes.

Uploaded by

ssunny128
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Form A

(See Rule 3)
Muster Roll ( Maternity Benefit Act 1961)
BIMARALA BAUXITE MINES, M/s
Name of Establishment Mineral & Mineral Ltd., PO: Adar,
Dist: Gumla, Jharkhand - 835231
1 Serial Number
Name of the woman and her Father or if married,
2
Husband Name NO CASE INVOLVED
3 Date of Appointment
4 Nature of work
Dates with month and year in which she is employed, laid
5
off and not employed
No. of days No. of days No. of days
Month Remarks
employed laid off not employed
No Any Maternity Leave Availed
6 Date on which the woman gives notice under Section 6
7 Date of Discharge or Dismissal, if any.
8 Date of production of proof of pregnancy under section 6
9 Date of birth of child
Date of production of proof of delivery or miscarriage or death
10

Date of production of proof of illness referred to in section 10


11

Date with the amount of maternity benefit paid in advance of


12
expected delivery
Date with the amount of subsequent payment of maternity
13
benefit.
Date with the amount of medical bonus, if paid under section 8
14

Date with the amount of wages paid on account of leave Nil


15
under section 9.
Date with amount of wages paid on account of leave under
16
section 10 and period of leave granted
Name of the person nominated by the woman under section 6
17

If the woman dies, the date of her death, the name of the
18 person to whom maternity benefit and / or other amount was
paid, the amount thereof, and the date of payment
If the woman dies and the child survives, the name of the
19 person to whom the amount of maternity benefit was paid on
behalf of the child and the period for which it was paid
Signature of the employer of the establishment authenticating
20
the entries in the muster roll
21 Remarks column for the use of the Inspector

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