4. Every certificate of expected confinement or confinement shall be completed in ink or other indelible substance and shall contain the following particulars:—
(a)the claimant's name;
(b)in the case of a certificate of expected confinement, the week in which it is to be expected that the claimant will be confined and the date of the examination on which the certificate is based;
(c)in the case of a certificate of confinement, the date and place of the confinement, and the date of the examination on which the certificate is based;
(d)the date on which the certificate is given;
(e)where the certificate is signed by a midwife, either the registered number of the midwife or her address and the date of her qualification;
and shall bear, opposite the word “Signature”, the signature of the person giving the certificate written after there have been entered on the certificate the claimant's name and the expected date or, as the case may be, the date of the confinement.