Notice Of Pregnancy 149 - Legal Draft

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Category : Notices

Maternity Benefit

Notice of Pregnancy

Form 19
(See Regulation 87)

I, ................................................. Insurance No. .......................................... wife of/daughter of ................................... hereby give notice of pregnancy.

Present address
......................................................................................................................
......................................................................................................................
......................................................................................................................
Present/last employee

Date ................

Signature or thumb impression
Confidential

*