β¨ Maternity Claim Form
1168 NEW ZEALAND GAZETTE No. 40
LESS TOTAL DISBURSEMENTS
(GST inclusive) $\square\square\square\square\square\square
AMOUNT PAYABLE
(GST inclusive) $\square\square\square\square\square\square
CERTIFICATION
I certify I have provided the above services in accordance with the service specifications in the Section 88 Notice and that the above information is correct.
Name of Lead Maternity Carer (Please print in capital letters)
____________________________________________________
Signature of Lead Maternity Carer
____________________________________________________
Date
___________
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Online Sources for this page:
VUW Te Waharoa —
NZ Gazette 2002, No 40
Gazette.govt.nz —
NZ Gazette 2002, No 40
β¨ LLM interpretation of page content
π₯
Claim Form for Second Trimester, Third Trimester, and Labour and Birth
(continued from previous page)
π₯ Health & Social WelfareMaternity, Claim Form, Second Trimester, Third Trimester, Labour and Birth, Health Benefits