Form K - {{ $report['establishment

FORM NO. K

[See sub-rule (1) of rule 16 of the Tamil Nadu Maternity Benefit Rules, 1967]

ANNUAL RETURN FOR THE YEAR ENDING {{ $report['period_end'] ?? '31-12-2024' }}

1. Name of the establishment with postal address	{{ $report['establishment_name'] ?? '' }}, {{ $report['address'] ?? '' }}
2. Name of the employer with postal address	{{ $report['employer_name'] ?? '' }}, {{ $report['employer_address'] ?? '' }}
3. Name of the Manager with postal address	{{ $report['manager_name'] ?? '' }}, {{ $report['manager_address'] ?? '' }}
4. Aggregate number of women employed (Permanent + Temporary)	{{ $report['women_employed'] ?? 'NIL' }}

Question	Number	Amount Paid (Rs.)
5. Women who worked ≥ 160 days in preceding 12 months	{{ $report['worked_160'] ?? 'NIL' }}	{{ $report['worked_160_amount'] ?? 'NIL' }}
6. Women who gave notice under Section 6	{{ $report['notice_sec6'] ?? 'NIL' }}	{{ $report['notice_sec6_amount'] ?? 'NIL' }}
7. Women granted leave on confinement notice	{{ $report['granted_leave'] ?? 'NIL' }}	{{ $report['granted_leave_amount'] ?? 'NIL' }}
8. Claims for maternity benefit paid	{{ $report['claims_paid'] ?? 'NIL' }}	{{ $report['claims_paid_amount'] ?? 'NIL' }}
9. Claims for maternity benefit rejected	{{ $report['claims_rejected'] ?? 'NIL' }}	{{ $report['claims_rejected_amount'] ?? 'NIL' }}
10. Claims for medical bonus paid (Sec. 8)	{{ $report['bonus_paid'] ?? 'NIL' }}	{{ $report['bonus_paid_amount'] ?? 'NIL' }}
11. Claims for medical bonus rejected	{{ $report['bonus_rejected'] ?? 'NIL' }}	{{ $report['bonus_rejected_amount'] ?? 'NIL' }}
12. Cases where leave for miscarriage was granted	{{ $report['miscarriage_leave'] ?? 'NIL' }}	{{ $report['miscarriage_leave_amount'] ?? 'NIL' }}
13. Cases where leave for miscarriage applied but rejected	{{ $report['miscarriage_rejected'] ?? 'NIL' }}	{{ $report['miscarriage_rejected_amount'] ?? 'NIL' }}
14. Additional leave for illness under Sec. 10 granted	{{ $report['illness_leave'] ?? 'NIL' }}	{{ $report['illness_leave_amount'] ?? 'NIL' }}
15. Additional leave for illness under Sec. 10 rejected	{{ $report['illness_rejected'] ?? 'NIL' }}	{{ $report['illness_rejected_amount'] ?? 'NIL' }}
16. Payments made to persons other than the woman concerned	{{ $report['paid_others'] ?? 'NIL' }}	{{ $report['paid_others_amount'] ?? 'NIL' }}
17. Women deprived of maternity benefit/bonus u/s 12(2)	{{ $report['deprived'] ?? 'NIL' }}	{{ $report['deprived_amount'] ?? 'NIL' }}
18. Payments made on orders of Appellate Authority/Inspector	{{ $report['appeal_payments'] ?? 'NIL' }}	{{ $report['appeal_payments_amount'] ?? 'NIL' }}
19. Cases where pre-natal & post-natal care provided free	{{ $report['prenatal_care'] ?? 'NIL' }}	{{ $report['prenatal_care_amount'] ?? 'NIL' }}
20. Number of women who died	{{ $report['died'] ?? 'NIL' }}	-
21. Number of women discharged/dismissed while working	{{ $report['discharged'] ?? 'NIL' }}	-

Date: {{ $report['date'] ?? '' }}

For {{ $report['establishment_name'] ?? '' }}

Authorised Signatory