Notice by an insured female for resuming work after confinement

Maternity Benefit
Notice to work

I, ………………………..

Insurance No……….

Wife of/Daughter of…………………….., do hereby give notice that I have taken/shall take up work for remuneration with effect from the …………….. day of …………….. 20…. I have drawn maternity benefit up to the ………………day of ……………….20………….

………………..
(Sd/-)

Dated ……………20…………..

Present address …………………
……………………………….

*