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Unum CL-1297-MA: Massachusetts Bonding Certification

Parents taking bonding leave under a Unum-insured Massachusetts paid family and medical leave plan need proof of the birth, and this one-page Documentation of Newborn Bonding Leave is one way to supply it. The health care provider records the child's name and actual date of birth and signs. Unum accepts other official proof of birth in its place, so the form is optional.

Who completes it

The employee or parent writes their name at the top. The health care provider enters the child's name and actual date of birth and signs, adding printed name, type of practice or job title, and phone.

Submitting and payment

How to submit it
The completed page goes to Unum's Benefits Center with the parent's leave request, usually by the fax number printed on the form.

Good to know

  • Other official proof works instead, if it shows the parent's name and relationship to the child, the child's name and the child's actual date of birth.
  • The provider certifies only the birth facts: there is no diagnosis, incapacity or leave-duration question on this page.
  • It applies only to employers with a Unum-insured private Massachusetts plan. A serious health condition claim under the same plan uses CL-1263-MA. Revision 08/25 is current.
  • The form carries a GINA notice asking providers not to include genetic information, and a fraud notice covering the provider's portion.

Get the official form

Download the current version from the source each time; forms change without notice.

Massachusetts Bonding Certification of Health Care Provider (Documentation of Newborn Bonding Leave)

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Is Unum's CL-1297-MA required for bonding leave?

No. The employee instructions say to have the health care provider complete the form or to provide other official proof of birth that includes the parent's name and relationship to the child, the child's name and the actual date of birth.

What does the provider fill in on CL-1297-MA?

Only the child's name and actual date of birth, then a signature, date, printed name, type of practice or job title and telephone number. The instructions ask the provider to answer all applicable parts fully, since missing information may delay the claim.