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Form K Under Maternity Benefit Act

The document is an annual return form for an establishment providing information such as the establishment's name, location, opening and closing dates, contact details for the employer and manager, medical officer details including qualifications and hospital facilities including number of beds for women employees, presence of a lady doctor and qualifications, presence of a qualified midwife, and whether a creche has been provided.

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9K views1 page

Form K Under Maternity Benefit Act

The document is an annual return form for an establishment providing information such as the establishment's name, location, opening and closing dates, contact details for the employer and manager, medical officer details including qualifications and hospital facilities including number of beds for women employees, presence of a lady doctor and qualifications, presence of a qualified midwife, and whether a creche has been provided.

Uploaded by

hdpanchal86
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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FORM K [See rules 15] Annual Return for the year ending on the 31st December 2011 1 2 Name

of the establishment Situation of the Establishment District State Nearest Railway Station 3 4 5 6 Date of opening of the establishment Date of closing, if closed Postal address of establishment Name of employer Postal address of employer 7 Name of managing agent, if any Postal address of managing agent 8 Name of agent or representative of employer Postal address of representative of employer 9 Name of Manager Postal address of Manager 10 Name of Medical Officer, attached to the establishment Qualification of medical officer attached to (b) the establishment (a) (c) (d) 11 (a) (b) (c) Is he resident at the establishment? If a part time employee, how often does he pay visits to the establishment? Is there any hospital at the establishment? If so, how many beds are provided for woman employees? Is there a lady doctor?

(d) If so, what are her qualifications? (e) (f) Place: Is there a qualified midwife? Has any creche been provided? For,

Date: /01/2012

Signature of Manager

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