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The Statutory Maternity Pay (Medical Evidence) Regulations 1987
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[F1PART IIU.K.FORM OF CERTIFICATE
Textual Amendments
F1Sch. Pt. II substituted (1.11.1991) by The Social Security (Miscellaneous Provisions) Amendment Regulations 1991 (S.I. 1991/2284), regs. 1, 24
MATERNITY CERTIFICATEU.K.
Please fill in this form in ink Name of patient | |
Fill in this part if you are giving the certificate before the confinement. | Fill in this part if you are giving the certificate after the confinement. |
| Do not fill this in more [F2than 20 weeks] before the week the baby is expected. | I certify that I attended you in connection with the birth which took place on ......./........../........when you were delivered of a child [ ] children. |
| I certify that I examined you on the date given below. In my opinion you can expect to have your baby in the week that includes ......./........../........ | In my opinion your baby was expected in the week that includes ......./........../........ |
| Week means a period of 7 days starting on a Sunday and ending on a Saturday. | |
| Date of examination ......../........../........ | Registered midwives |
| Date of signing ......./........../........ | Please give your [F3NMC] Personal identification Number and the expiry date of your registration with the [F3NMC] . _________________ _________________ |
| ___________________________________ | |
|---|---|
| Signature: | |
Doctors Please stamp your name and address here [F4(unless the form has been stamped, in Wales, by the Local Health Board in whose medical performers list you are included or, in Scotland,] [F5by the Health Board in whose primary medical services performers list you are included)]. | |
______________________________] | |
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