Application for Pro Rata Adjustment of CPD Hours

Application for Pro-Rata Adjustment of CPD Hours
Please fill out the form below to apply for a pro-rata adjustment of your CPD hours. Ensure all required documents are attached before submission.
Full Name:*

First NameLast Name
Company Name:
LIA Membership No.*
Email Address:*
Contact Tel. No.*
Reason for Application:
MaternityIllnessParentalOther
If selected 'other' please specify your reason:
Documents Required:
Doctors Report (required for illness)

Cancelof
Letter from Employer *

Cancelof
Leave Periods:
Maternity Leave:
maximum 26 weeks statutory leave and 16 weeks unpaid leave.
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Sick Leave:
minimum of 2 months or more.
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Parental Leave:
maximum 22 weeks per child in a 12 month period.
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For Parental Leave, please confirm the number of children aged 12 years or under.
Other Leave:
From blanks To: blank
Member Signature:

Clear
Date of Signing:

DayMonthYear
Date
Should be Empty:

Application for Pro-Rata Adjustment of CPD Hours