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Maternity Benifits Application Form 2013
In Parts 1, 2, 3, 5, 7 and 8 as they
apply to you. When form is completed, read Part 9 and sign declaration in Part 1.
Please note photocopies of this declaration are not acceptable.
To qualify for the maximum period of 26 weeks maternity leave, an employee
must take at least 2 weeks before the end of the week in which her baby is due.
Doctor:
Please complete and stamp Part 6 after the 24th week of pregnancy.
Employer:
Please complete and stamp Part 4 after the 24th week of pregnancy.
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