STATUTORY RULES.
1935. No. 56.
REGULATION UNDER THE MATERNITY ALLOWANCE ACT 1912-1934.*
I, THE GOVERNOR-GENERAL in and over the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulation under the Maternity Allowance Act 1912-1934.
Dated this twelfth day of June, 1935.
(Sgd.) ISAAC A. ISAACS,
Governor-General.
By His Excellency’s Command,
Acting Treasurer.
Amendment of the Maternity Allowance Regulations.†
Form B in the Maternity Allowance Regulations is repealed, and the following Form inserted in its stead:—
Form B. Reg 2.
The information in this Form is confidential.
Commonwealth of Australia.
Maternity Allowance Regulations.
MATERNITY ALLOWANCE CLAIM.
To the Deputy Commissioner of Maternity Allowances.
1. I,.............................................at present residing at
[Here write full name.]
.............................................................gave birth to a
[Here write full postal address.]
............................child at........................................
[Here write “male” or “female”.] [Here write full postal address.]
on the.................day of...................., 19.... My usual place of residence
is...................................................
[Here write full postal address of usual residence]
2. I hereby claim payment of a maternity allowance and I request that the money order be made payable at
[Here write name of Post Office where it is desired to receive payment]
Post Office, and that it be forwarded to me at the following address, namely,
......................................................................
[Here write full postal address to which it is desired the money order be sent.]
* Notified in the Commonwealth Gazette on , 1935.
† Statutory Rules 1926, No. 172, as amended by Statutory Rules 1931, No. 92; 1934, No. 126; and 1935, Nos. 38 and 40.
2098.—8/30.5.1935.—Price 3d.
3. I was attended at or soon after the birth by Doctor...............................
[Here write full name
............................and by.......................................
and address.] [Here write full name
..................................................
and address of midwife or other person acting as such.]
4. I am the mother of the following children who were alive and were under fourteen years of age at the date of the birth of the child in respect of whom this claim for a maternity allowance is made:—
Full name of child. | Date of birth. | Place of birth. |
|
|
|
5.*I am an inhabitant of the Commonwealth.
*I intend to settle in the Commonwealth.
*Strike out words which are not applicable.
6. I am not an alien, and I am not an aboriginal native of Australia, Papua, or an island of the Pacific.
7. During the period of twelve months preceding the date of the birth of the child, the income of myself and my husband from all sources amounted to £ †
8. The names and addresses of the persons from whom my husband or myself derived the above-mentioned income are......
....................................................................................
9. The child............................................................
[State here whether the child lived for more than twelve hours or less than twelve hours, or was still-born.]
10. The birth was registered at...............................................
11. The full name of the child is ‡............................................
‡If the child is not named, say so.
Signature of mother...........................................
[Or her mark if she cannot write.]
Date of signature or mark.......................................
Signature of witness to mark.....................................
†Income includes salary or wages, rents (after deduction of repairs, &c.), dividends from banks or companies, interest on money lent or on bonds or on money in bank, war pension, and any other income. In the case of a posthumous or ex-nuptial child, the total income of the claimant only for the twelve months preceding the date of the birth is to be shown.
Any person who makes or presents to the Commissioner, or to any officer, any statement or document which is false in any particular is liable to a penalty not exceeding One hundred pounds or imprisonment for a term not exceeding one year.
By Authority: L. F. Johnston, Commonwealth Government Printer, Canberra.