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Total Weekly earnings of Applicant
Total Weekly earnings of other members of family living with
Applicant
This form, accurately completed, must be returned before the
confinement.
I, the undersigned, declare the above statement to be true.
Signed
Date
Home Help II.
Form of application for payment.
COUNTY BOROUCH OF WEST HAM.
Medical Officer of Health's Department.
I Certify that I acted as Home Help to:
Mrs :.
of
from the day of to the day
of and apply to the Council of the County Borough
of West Ham for the sum of being at the rate of
£1 1s. 0d. per week.
Signed
Address
Date
The above-named Home Help acted as stated.
Health Visitor.
Certified
By the employment of a Home Help the mother is enabled to
obtain a longer rest after confinement than would otherwise be
possible; her physical condition improves, and much after illhealth
is prevented; also, she benefits mentally: she is freed from
the worries and anxieties that the other children might suffer
while she is confined to bed, in the knowledge that the Home Help
is undertaking all the duties and management of the home and
children.
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