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Attestation of Pregnancy - previous version

Form number: 1028

This form is to be used for applications relating to the September 1, 2016–August 31, 2017 award year.

You need to use this form when you have reached the 20th week of your pregnancy.

This form will not be considered valid unless it has been signed after the 20th week of your pregnancy by your doctor or by the medical practitioner who follows you during your pregnancy.

Digital transmission

Once you print the form, you must fill it out, have your doctor or the medical practitioner that monitors you during your pregnancy fill in Section 3 and sign it, then sign the form yourself and scan it. Use our Online Services to upload the completed form.

Other way to submit your document

Mail

If you are unable to submit this form digitally you can mail it to us. Print the form, fill it out, have your doctor or the medical practitioner that monitors you during your pregnancy fill in Section 3 and sign it, then sign the form yourself and mail it to the address shown on the form itself. 

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