FORM 'J' (Sec Rule II) To ............ ......... Sir, Shri Inspector, having directed under sub-section (2) o Section 17 to pay the Maternity Benefit or other amount being (nature of amount) to which (name of woman) is said to be entitled, I prefer this appeal under sub- section (3) of Section 17. In view of the facts mentioned in the memorandum attached hereto and other documents filed herewith it is submitted that the women is not entitled to the maternity benefit to the said amount and hence the decision of the Inspector in this behalf , copy of which is which is enclosed may be set aside. Signature of aggrieved person. Dated...... Full address........
