Maternity Benefit Application Form (MB1)

Published date05 July 2021
IssuerDepartment of Social Protection
What is Maternity Benefit?
Maternity Benefit is a payment for employed and self-employed people who are on maternity
leave from work and are covered by social insurance (PRSI). To qualify for the maximum 26
weeks maternity leave, you must start your maternity leave at least two weeks before the end of
the week in which your baby is due.
What do I need to complete this application form?
You will need your Personal Public Service Number (PPS Number) along with information on
where you live, your children, your relationship status and where you want your payment to issue.
If you are an Employee:
Please fill in Parts 1 to 6 as they apply to you, ensuring you read Part 7 Checklist and sign the
declaration in Part 4.
You will also need to ask your employer to complete the Employer Certificate (MB2) which is
attached to this form.
If you are Self-Employed or recently finished insurable employment:
Please fill in Parts 1 to 6 as they apply to you, ensuring you read Part 7 Checklist and sign the
declaration in Part 4.
You will also need to ask your doctor to complete the Medical Certificate (MB3) which is also
attached.
How to complete this application form?
Please use this page as a guide to filling in this form.There is an example on the back.
Please use BLACK ball point pen.
Please use BLOCK LETTERS and place an X in the relevant boxes.
Please answer all questions that apply to you, leave blank any that don’t apply.
How do I apply?
You can apply online at MyWelfare.ie, or
Send this completed form to:
Maternity Benet Section
Department of Social Protection
McCarter’s Road
Buncrana
Co. Donegal
F93 CH79
Important: Please send this form at least 6 weeks (12 weeks if self-employed) before you intend
to start your maternity leave. Please do not send this form more than 16 weeks before the end of
the week in which your baby is due.
If you need any help to complete this form, please contact the Maternity Benefit Section, any
Citizens Information Centre, your local Intreo Centre or your local Branch Office.
For more information visit www.gov.ie
Application form for
Maternity Benet
Data Classication R
Social Welfare Services
MB 1
How to fill in first page of this form
To help us in processing your application:
Print letters and numbers clearly.
Use one box for each character (letter or number).
Please see example below.
Contact Details
1234567T
M U R P H Y
M A U R E E N
M C D E R M O T T
1. Your PPS Number:
3. Surname:
4. First name(s):
Mr Mrs Ms Other
2. Title: (insert an X or
specify)
5. Birth surname:
X
O N E C H A R A C T E R P E R
B O X
8. Your telephone number:
9. Your email address:
O N E N U M B E R P E R B O X
1 N E W S T R E E T
O L D T O W N
D O N E G A L T O W N
7. Your address:
County D O N E G A L
A 1 2 B 1 2 3
2 8 0 2 1 9 9 06. Your date of birth:
D D M M Y Y Y Y
SAMPLE
Eircode/Postcode

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