Paternity Leave

Application Form

Before completing this form, please read the UECS Family Leave Policies document.

You should download this form and save it on your computer before completing it.

Employee Details

Surname:	Click to enter text	Forename/s:	Click to enter text
Department:	Click to Select	Personal Reference No:	Click to enter text

Details of Paternity Leave

Please attach the original MATB.1 / matching certificate given to you by your midwife / GP / adoption agency.
Expected week of childbirth / placement of child:	Select Date …
Planned date of commencement of paternity leave and pay:	Select Date …
Planned date of return from paternity leave	Select Date …
Planned date of commencement of paternity leave and pay (if taking in two blocks of one week):	Select Date …
Planned date of return from paternity leave (if taking in two blocks of one week)	Select Date …

Employee Declaration

I confirm that I am the father or secondary adopter of the child or the partner of the mother or main adopter:	☐
Print Name:	Click to enter text	Date Signed:	Select Date …
Signed:
Sign the form by either typing your name or uploading a JPEG image of your signature. Save the completed form and send it by email to People & Culture, and your manager. This form should be submitted no later than the 15th week before the expected week of childbirth, or within 7 days of being matched with a child and at least 28 days before the anticipated start date of your adoption leave.