FORM J
[Rule 11]
APPEAL UNDER SECTION 17

To
Sir,
Shri ______, Inspector, having directed under sub-section (2) of 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 woman is not entitled to the maternity benefit or the said amount and hence the decision of the Inspector in this behalf, copy of which is enclosed, may be set aside.
Date _______ Signature of aggrieved person.
Full address ____________