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318.751 - Supplementary Maternity Allowance Application Form

For the attention of applicants with multiple employers

Maternity allowance applicants must provide details of all their employers (Form 318.750). Claimants with multiple employers must complete the present supplementary application form for each of her employers and send it, together with the main application form, to one compensation fund. Multiple maternity allowance claims are not permitted.

In the interests of a prompt assessment of your application, we kindly request that you ensure that the information you provide is accurate and complete. Please mark the appropriate boxes.

Additional information The assessment of your application shall comply with the following legislation:

Paper version for print

If you want to fill in the form by hand, you can use the below PDF file. This version can not be completed online.