Forms X explained: this guide covers what it means, who it applies to, the step-by-step process, documents required, fees, due dates and penalties in India — so you can stay compliant with confidence and avoid costly mistakes.
Forms X, XI and XII are the working forms of maternity benefit under Chapter VI of the Code. Form-X is the medical certificate; Form-XI is the woman's notice of claim (Part I) and the receipt of payment (Part II); and Form-XII is the appeal to the competent authority if maternity benefit or medical bonus is denied or she is dismissed.
A woman proves pregnancy, delivery, miscarriage, medical termination of pregnancy, tubectomy or related illness with a Form-X certificate. She gives her employer notice in Form-XI, naming a nominee, and the employer obtains a receipt in Form-XI Part II when paying. Wages for illness leave are paid within forty-eight hours of the Form-X certificate (rule 35(2)(f)). A woman deprived of maternity benefit or medical bonus may appeal in Form-XII within sixty days (Form-XIV abstract, para 7(2)(b)).
Context
Rule 35 covers the certificate and notice of claim, and rule 38 the appeal; see rules 34 and 35 and rule 38. The Code provisions are in sections 59 and 60, sections 61 to 64 and sections 68 to 70. The Central Rules apply where the Central Government is the appropriate Government; State-sphere employers follow State rules. For HR policy and a forms pack for your establishment, our employment and labour law advisory team can help.
| Form | Rule | Who | Purpose |
|---|---|---|---|
| X | 35(1)(a), (d), 35(2)(f) | Medical officer or practitioner (ASHA, ANM and others for some facts) | Certificate of confinement, miscarriage, MTP, tubectomy, delivery, illness, or death |
| XI Part I | 35(2)(a) | Woman employee | Notice of claim and nomination |
| XI Part II | 35(2)(c) | Woman, nominee or legal representative | Receipt of maternity benefit |
| XII | 38(2) | Woman employee (or nominee or representative) | Appeal under section 68 |
Form-X: the certificate
Rule 35(1)(a) says the fact that a woman is pregnant, has been delivered, has had a miscarriage, medical termination of pregnancy or tubectomy, or is ill because of these shall be proved by a Form-X certificate from a registered medical practitioner, an Accredited Social Health Activist or a qualified Auxiliary Nurse and Midwife. Other routes are allowed for some facts: confinement may also be proved by a birth certificate from the municipality or gram panchayat, a birth register extract, or a certificate signed by an ASHA, ANM, Gram Pradhan, Village Administrative Officer or authorised municipal officer (35(1)(b)); a miscarriage by an ANM's certificate (35(1)(c)); and death of a woman or child by Form-X or a certified death register extract (35(1)(d)).
Contents as printed. Three alternative certificates, to be struck out as needed: (1) the signatory examined the woman and found she is pregnant and expected to deliver within a stated period, or has had a miscarriage, MTP, tubectomy or delivery, or is suffering from illness arising out of these; (2) the woman died before, during or after confinement, and the child died or survives; (3) the signatory examined her and found she has delivered or miscarried on a stated date. It is signed by the Medical Officer, Medical Practitioner, ASHA, ANM, Gram Pradhan, Village Administrative Officer or authorised municipal officer. The form also prints the Code's meaning of "child" (includes a still-born child) and "miscarriage" (expulsion of the contents of a pregnant uterus at any period prior to or during the twenty-sixth week, excluding a miscarriage whose causing is punishable under the Indian Penal Code).
Why it matters. It triggers timed payments: the wages for leave for illness are paid within forty-eight hours of the certificate (35(2)(f)), as the Form-XIV abstract repeats for miscarriage or MTP leave and illness leave.
Form-XI: notice and receipt
Part I, Notice (rule 35(2)(a)). The woman states that she expects to be confined within six weeks next following the notice, or has given birth on a stated date, and will be absent from a stated date; that she will not work in any establishment while receiving maternity benefit; and, for section 63, nominates a person (name and address) to receive maternity benefit or other amounts due if she dies. Signature or thumb impression, with an attester if she cannot sign. Rule 35(2)(a) adds that the nominee's Aadhaar details are provided when filling; that a plain paper or electronic application may be accepted by the employer instead; and that no claim is invalid merely because the prescribed form was not used.
Part II, Receipt (rule 35(2)(c)). The employer obtains a receipt when paying. It records the amounts received: the first installment of maternity benefit, the second installment after delivery, the medical bonus under section 64, and wages for leave under section 65, with dates, and the dates of confinement, miscarriage, MTP or tubectomy or illness. It is signed by the woman, her nominee or her legal representative.
Payment timing in rule 35. The medical bonus is paid with maternity benefit (35(2)(d)). Payment after the woman's death is to be made within two months of death (35(2)(e)); in case of doubt the employer deposits the amount with the competent authority within two months of death, and the enquiry is completed within three months of deposit, extendable for reasons by up to three months (35(2)(b)).
Form-XII: appeal under section 68
Form-XII is an appeal to the Competent Authority appointed under Chapter VI. The woman states that she has been wrongly deprived by the employer of maternity benefit or medical bonus or both, or wrongly discharged or dismissed during or on account of absence from work, gives reasons, and requests an order that the employer pay or that the discharge or dismissal be set aside, with a copy of the employer's order enclosed. It has signature space for the woman, nominee or legal representative, an attester, and the full address.
Key rules around it:
- Rule 38(2): the appeal is in Form-XII, in writing, handed over, sent under registered cover or made electronically.
- The authority gives the employer a copy, asks for a reply and documents, and decides within three months, extendable for reasons by up to three months; if the employer does not reply it may decide ex parte.
- The Form-XIV abstract says that a woman deprived of maternity benefit or medical bonus may appeal within sixty days of the day the order was communicated, and the decision is final.
- Gross misconduct that allows deprivation is listed in rule 38(1): wilful destruction of property, assault, a conviction for an offence involving moral turpitude, theft, fraud or dishonesty, and wilful non-observance of safety measures.
- Rule 40(2) and (3): the employer supplies Forms X, XI, XII, XIII-A and XIII-B without charge on request, and failure to use the form does not affect the right; an authority may, within fifteen days, require the correct form.
Example. A woman employee gives Form-XI notice with her nominee's name, and the employer pays. She signs the Part II receipt for the first installment. Later she falls ill because of delivery and presents a Form-X certificate; her wages for the leave period are due within forty-eight hours.
Need help with maternity benefit compliance?
Missing a forty-eight-hour payment or rejecting a claim for a form defect are avoidable errors. Our employment and labour law advisory team can help you set up forms, registers and payment checks.
Key takeaways
- Form-X certifies pregnancy, delivery, miscarriage, MTP, tubectomy, illness or death and triggers timed payments.
- Form-XI has a notice with a nominee (Part I) and a receipt (Part II); use of the form is not a condition of the claim.
- Form-XII appeals a deprivation or dismissal to the competent authority, within sixty days per the Form-XIV abstract.
- The employer must supply these forms without charge on request.
- State-sphere employers follow State rules.
Read next
- Rules 34 and 35: competent authority and maternity benefit claims
- Forms XIII-A, XIII-B and XIV: complaint, appeal and abstract
- How to claim maternity benefit: employee process
- Maternity benefit under the new labour codes
Disclaimer: Based on the Code on Social Security, 2020 (as enacted) and, where noted, the Code on Social Security (Central) Rules, 2026 (G.S.R. 344(E), 8 May 2026), as on 30 September 2026. The Code is in force from 21 November 2025; some provisions may be notified later, and State Governments make their own rules for establishments where the State is the appropriate Government. Verify the current position before acting.