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318.752 - Employer declaration form

(for women who are unemployed and not in receipt of unemployment benefits)

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

The present employer declaration applies only to women who are unemployed and not in receipt of unemployment benefits.

The present declaration must be submitted by the woman concerned to the relevant compensation fund, together with the maternity allowance application form (318.750).

Additional information Assessment of eligibility for a maternity allowance 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.