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[Section 16]
[Entire Act]
State of Punjab - Subsection
Section 16(2) in The Punjab Maternity Benefit Rules, 1967
| 1 | Serial Number | |
| 2 | Name of woman and her father's or if married husband's name | …............ |
| 3 | Date of appointment | …............ |
| 4 | Nature of work | …............ |
| 5 | Dates with month and year in which she is employed laid offand not employed | …............ |
| Month | Number of days employed | Number of days laid off | Number of days not employed | Remarks |
| 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 | …............ |
| 10 | Date of production of proof of delivery or miscarriage ordeath | …............ |
| 11 | Date of production of proof of illness referred to in section10 | …............ |
| 12 | Date with the amount of maternity benefit paid in advance ofexpected delivery | …............ |
| 13 | Date with the amount of subsequent payment of maternitybenefit | …............ |
| 14 | Date with the amount of medical bonus, if paid under section 8 | …............ |
| 15 | Date with the amount of wages paid on account of leave undersection 9 | …............ |
| 16 | Date with amount of wages paid on account of leave undersection 10 and period of leave granted | …............ |
| 17 | Name of the person nominated by the woman under section 6 | …............ |
| 18 | If the woman dies, the date of her death the name of theperson to whom maternity benefit and/or other amount was paid,the amount thereof and the date of payment | …............ |
| 19 | If the woman dies and the child survives, the name of theperson to whom the amount of maternity benefit was paid on behalfof the child and the period for which it was paid | …............ |
| 20 | Signature of the employer of the establishment authenticatingthe entries in the muster roll | …............ |
| 21 | Remarks column for the use of the Inspector | …............ |