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Maternity Certificate (form MAT B1)
Please use this form if you are requesting for a certificate for MAT B1. This certificate
•verifies the pregnancy
•confirms the date of the expected week of confinement (EWC)
•confirms the actual date of birth when completed after confinement
Read:
https://www.gov.uk/government/publications/maternity-certificate-mat-b1-guidance-for-health-professionals/maternity-certificate-form-mat-b1-guidance-on-completion
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* Indicates required question
Issued
MAT B1s are only issued if
•only when you are satisfied your patient is pregnant
•not more than 20 weeks before the expected delivery date
YOUR DETAILS
Please include your latest personal details so that we can contact you if necessary
Your Full Name
*
Your answer
Your Date of Birth
*
Please include your DOB in the form of DD/MM/YYYY i.e 01/01/1980
MM
/
DD
/
YYYY
Your MOBILE number
*
If we need to contact you to clarify your answers especially if your asthma is poorly controlled
Your answer
Your EMAIL address
*
Your answer
MAT B1 REQUEST
Are you pregnant?
*
No, I am NOT pregnant NOR given birth in last year
Yes, I am currently pregnant
No, BUT I have given birth in the last 1year
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