Get more information about eligibility and how to claim.
You’ll need to include your Test Period dates in the claim form. Your Test Period is the 66 weeks before the week you expect to have your baby. Use the Test Period calculator to find out these dates.
Before you start this form
If you’re using a mobile phone or tablet
You cannot complete the form using a mobile phone or tablet. You have to either:
- use a desktop or laptop computer
- print the form and complete it by hand
If you’re using a desktop or laptop computer
Use a PDF reader to open and fill in this form. You can download a free PDF reader online.
If you are using screen reader software to access the form, we recommend that you review all of the notes and the questions on the form before you complete it. As you complete the form, you will be guided through the questions based on the responses you provide.
Do not use your computer’s browser or, if you are an Apple Macintosh user, the Preview application.
You can save data typed into this form if you use a PDF reader. This means that you do not have to fill in the form in one session.
There are reliability issues with some assistive software, which may mean the form will not save properly.
This form will only save if it is both:
- saved onto your computer
- opened in a recent version of PDF reader
The form will not save in:
- versions of Acrobat Reader older than version XI
- some other PDF readers, for example Preview on a Mac or Foxit on a PC
Help using this PDF claim form
For help and advice on the information you need to put on the form or about the benefit you want to claim, contact the Maternity Allowance line at Jobcentre Plus.
Contact the DWP Online Helpdesk, if you are having technical difficulties:
- downloading the form
- navigating around the form
- printing the form
Order a printed claim form
If you cannot download or print the claim form, you can ask for a form to be posted to you.
This service is only available if you live in England, Scotland and Wales. There is a different process in Northern Ireland.
Find out how to ask for a claim form in Northern Ireland
Order a claim form
If you need this form in a different format
For other formats, such as braille, large print or audio CD, contact Jobcentre Plus.