FORM 24: Maternity Benefit
[Regulation 91]
NOTICE OF WORK
I,___________ ,wife/daughter of ___________ Insurance No _________________ do hereby give notice that I have taken/ shall take up work for remuneration from ____________________
I have drawn maternity benefit only up to ______________________
Date ____________________
Present address (if changed)____________
Signature or thumb-impression
Local office ____________