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or after 1/1/1999. (SIGNATURE) II. INFORMATION FOR THE REQUESTER 1. Member's name, SS NUMBER on the application and date of birth; 2. Name of the pregnant woman, SS NUMBER on the application and date of birth; 3. Father's name and SS NUMBER, if male; 4. Date and place of birth; 5. Postponement date, if known; 6. Prenatal diagnosis (for case of abnormal labor) or indication on the certificate of delivery if normal labor was observed. 7. Social security number (SSN) or driver's license numbers; 8. Date and place of delivery. 3. Information for the applicant Please indicate whether or not you are the sponsor or a legal guardian. If you are a legal guardian, please indicate the relationship with the pregnant woman, father's name, mother's name, SS number, father's SS number, father's name, mother's name, date and place of birth, and the pregnancy date in bold print on the application. If you are a sponsor, please indicate the relationship with the applicant: a) Sponsor/Parent : If you are sponsoring a minor Name: Last Name: SS Number or Drivers License Number: Father's Name: SS Number: Mother's Name: SS Number: Date and place of birth: (if applicable) Social Security Number: Mailing Address: Mailing Address: (Address, City, State, Zip Code) Postmark Date: Maternity Health Care: Date and place of delivery: (if applicable) Name of Sponsor/Parent: 1. Signature (if applicable) 2. Name of sponsor for child (if applicable) 3. Date and place of birth: (if applicable) 4. Social Security Number (SSN), License No or Driver's License Number If the applicant is a sponsoring parent or legal guardian and the information is not shown on the application, the applicant should obtain a copy from the State Registrar. Prenatal Diagnosis for Case of Abnormal Labor, Indication on Certificate of Delivered Abnormal Labor If Prenatal Diagnosis: Abnormal Prenatal Diagnosis (ACD); Infant's Indications on Certificate of Delivered Abnormal Labor (DID) Treated for Abnormal Prenatal Diagnosis or Indication Indicated as Abnormal Prenatal Diagnosis (ACD) or Ind

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What is MAT 1 Form for? This form is created by the Social Security System to notify the employer that a female employee is expecting a baby.