Application for Pro-Rata Adjustment of CPD Hours
If you've had to take time away from work — whether due to illness, maternity leave, parental leave, or another reason — you may be entitled to have your CPD hours adjusted on a pro-rata basis. Please complete this form as fully as you can and attach any supporting documents. If you're unsure about anything, don't hesitate to get in touch with us.
Full Name:
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First Name
Last Name
Company Name:
*
LIA Membership No.
*
Email Address:
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Contact Tel. No.
*
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Reason for Application:
Please select one of the following options:
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Maternity
Illness
Parental
Other
Leave Period:
Rows
From (DD/MM/YYYY)
To (DD/MM/YYYY)
Maternity Leave (max 26 weeks statutory + 16 weeks unpaid)
Sick Leave (minimum 2 months)
Parental Leave (max 22 weeks per child)
Other Leave
If selected 'other' please specify your reason:
Documents Required:
Doctors Report (required for illness) / Letter from Employer
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Member Signature:
Date of Signing:
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Month
Year
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