Form B[See Rule 4 (1)]This is to certify that I examined..................... wife/daughter of..................a woman employee in (name of establishment) on....................(date) and found/cannot discover that she is pregnant and is expected to be delivered of child within......................(month and days) from the abovementioned date/has undergone miscarriage/has been delivered of a child on (date) or is suffering from (date) from illness arising out of the pregnancy/delivery/premature birth of a child or miscarriage..............Date......................Signature, qualifications and designation ofMedical Officer/Medical Practitioner.Definitions of "child" and "Miscarriage" as in the Maternity Benefit Act, 1961.
