Form VIII

[See Sub-Rule (1)(a) and (d) of Rule-22]

Certificate of Medical Officer/Medical Practitioner for

confinement/miscarriage/ Medical termination of

pregnancy or tubectomy operation/ delivery of a child/adoption of child

This is to certify that-

1. *I examined…………………….wife/daughter of………………………… Woman

employee in………………………………….………………………………………(Name of

the establishment) on……….. (Date) and found/ cannot discover that she is

pregnant and is expected to be delivered of a child within (month and/days) from

the above mentioned date/ has undergone miscarriage/ Medical termination of

pregnancy or tubectomy operation/has been delivered of a child on…….……

(Date) or is suffering from………..…(date) from illness arising out of

pregnancy/delivery/ premature birth of a child or miscarriage/ Medical

termination of pregnancy or tubectomy operation.

2.*Smt……………………………………wife/daughter of……………………. Employed

in………………………………………………………………………………………………………

……………. (Name of the establishment) expired on …………………….

before/during/ after confinement. The child died on……/survives her.

3. *I examined……………………..wife/ daughter of……………………………a woman

employed in……………………………………………………………………………(Name of

establishment) and found that she has been delivered of a child/ has undergone

miscarriage on……… (date).

(*Strike out unnecessary portion)

Signature, qualifications and designation of

Medical Officer/Medical Practitioner/Midwife

Date………

Definitions of "child" and "miscarriage" as in the Code on Social Security, 2020.-

1. "Child" includes a still-born child.

2. "Miscarriage" means expulsion of the contents of a pregnant uterus at any

period prior to or during the twenty-sixth week of pregnancy but does not include

any miscarriage, the causing of which is punishable under the Indian Penal Code.