BT ‘TO THE DOCTOR OR MIDWIFE - Please fill n this form in ink. Name of patient [Part A Fillin this par if you are giving the certificate before the confinement. o not fil this in more than 20 weeks before the week when the baby is expected. 1 certify that I examined you on the date given below. In my opinion yoy gan expect to have your baby inthe week that includes FILL JO LE ‘Week means o period of 7 days starting on a Sunday and ending on o Saturday. Date of examination $ Date of si ing OS.I.1O.1.28.22 signature LDCs TO THE PATIENT Please read the notes on the back of this form -| centiicate number | 004323371 J Fill n this part ifyou ore giving the certificate after the confinement. I certify that I attended you in connection with the birth which took place on Jeune WheN YOU Were delivered of a child {" }children. Jn my opinion your baby wos expected inthe week tht FnClUdOS snd Registered midwives Please give your NMC Personal Identification Number nd the expiry date of your [y — foataorwinienve AIT 2ZE_ | Doctors Please stamp your nome and adress here ifthe form has ot been stamped by the Health Authority in whose mecca st you are included MAT B1 12/2018This is your Maternity Certificate to cioim statutory Maternity Pay or Maternity Allowance Full name TATNMeH Qnzmnw Address Be Wa0d0n raed, Ave Ceoyon, e@o Lv Date of birth 2B 1X NGS National insurance number [Statutory Maternity Poy GHP) ] You maybe eiiled to 3 rom on employe you have been crmloye by the srt employer amine seghng eyo pregnancy, You ned oe out employer st eos to don Rote ofthe dts You want jour SUE toot Ask your employer you con get SHP. you hove more thon one trvpaye cok eac of tem De snow Give this cetcate o your employe to get SMP Ifyou cannot get SHP, you employer must giv you back is cercee with form SHPL so you concn Hato Alowenes. More information [ Maternity Allowance (MA) You may be able to get MA if: + your employer cannot pay you SMP, or + you are self-employed or do not have an employer + you are neither employed nor self-employed but take port in the business of your self-employed spouse or civil partner Ifyou think you may be entitled to MA, get form MAI from the Jobcentre Pius claim-line on 0800 O55 6688 or if you are Welsh (0800 012 1888. If you have speech or hearing difficulties you can Contact the cloim line using a textphone on 0800 023 4888. You can also get an MA1 from your antenatal clinic, or download it from www.gov.uk/maternity-allowance/how-to-claim There are time limits for claiming SMP and Maternity Allowance. You may There is more information in your bounty pack, or ask ot lose money if your claim is late. Visit www.gov.uk for more information about SMP and MA and ot! for you and your forily. For example: + Child Benefit + Tox Credits Best Start Grant (for people living in Scotland) Sure Start Maternity Grant (for people living in England or Wales) your ante-natal clinic. ‘To make sure you understand your pregnancy and maternity related employment rights as soon as possible, please visit ‘www.gov.ukiworking-when-pregnant-yor ther help