Home / Code on Social Security / Central Rules 2026
Form guide · Source checked 21 October 2026
Social Security Form X: maternity medical certificate format
Prescribed evidence format for pregnancy, delivery, miscarriage, termination, tubectomy or related illness; only an authorised genuine practitioner/officer can certify actual facts.
See rule 35(1)(a), 35(1)(d) and 35(2)(f) · Social Security (Central) Rules, 2026 · Central-sphere scope
Download and read the completed example
Completed fictional maternity medical certificate format for Sahyadri Illustration Services Pvt Ltd (fictional), 14 Example Park, New Delhi 110001. It illustrates the prescribed fields without executing a signature or official act.
Fictional, unsigned completed illustration. It demonstrates this form’s fields; it is not a filed return, medical opinion, official order or proof of an actual transaction.
When and how this form is used
Rule 35 uses Form X for specified medical/event evidence. Select the correct branch; a forecast of delivery is different from proof of delivery or a death-related entry.
This completed format is not a medical diagnosis or valid medical certificate. The actual evidence must come from a person authorised for the relevant certificate under the Rules.
The completed fields
Selected delivery-certificate branch
| Prescribed field / section | Completed fictional entry |
|---|---|
| Woman / parent / establishment | Priya Rao, daughter of Meera Rao (fictional), Sahyadri Illustration Services Pvt Ltd (fictional), 14 Example Park, New Delhi 110001 |
| Employment / contact | Accounts assistant; employee DEMO-MAT-01; priya@example.invalid; 6 Example Road, New Delhi 110001 |
| Examination / delivery date | Examined 21 September 2026; hypothetical delivery 20 September 2026 |
| Finding recorded for illustration | Delivery of a child on 20 September 2026; no death, miscarriage, termination, tubectomy or associated illness asserted |
| Other alternative clauses | Pregnancy forecast and death-related branches N/A in this delivery scenario |
| Certifier name / capacity | Dr Asha Sen (fictional medical practitioner); no registration number invented |
| Certificate / date / signature | 21 September 2026; Signature / seal / certification not executed; typed name is an illustration only |
Supporting records and reconciliation
Genuine examination/event evidence and the authorised certifier’s actual details; restrict access to medical information.
Official source and version
Official Gazette, Social Security (Central) Rules, 2026; Form X; PDF pages 217–217
Download the official source pages containing this form. Adjacent prescribed forms can share a source page; use the heading and rule identified above.
The Central Rules have their stated jurisdiction. The corresponding appropriate-government rules and any later amendment must match the real establishment and event.
Practical questions
Can I submit the sample as my own completed form?
No. Replace the fictional facts with accurate records, use the competent filing or record-keeping route described above and complete genuine signatures or certifications where required.
What makes the example specific to this form?
The sample selects the delivery branch and explicitly marks unrelated medical/death alternatives N/A; it does not certify that any real patient was examined.