Language
English (UK)
Bulgarian
Română
Polski
Russian
Italiano
Paternity Leave Request Form
You can use this form to request paternity leave (and statutory paternity pay (SPP), if applicable) under the right provided in law to take time off work to help care for a child or support the child’s mother or adopter. Before completing this form, you should first check that you are eligible to make a paternity leave request. For further information, please speak to the HR Department.This document will help the Company to process your request if you provide as much information as you can. It is important that you complete all the questions as otherwise your request may not be valid. We understand that dates may change with short notice, we please ask that you notify your manager at the earliest possible stage of any date amendments.
Name
*
First Name
Last Name
Due Date
*
-
Month
-
Day
Year
Date
If the baby has already been born, please provide the date of birth
-
Day
-
Month
Year
Date
In the case of an adopted child, the date on which the adoption agency told the adopter that they had been matched with a child:
-
Day
-
Month
Year
Date
In the case of an adopted child, the date on which the child is expected to be placed for adoption (or, if the child has already been placed, please provide the date of placement)
-
Day
-
Month
Year
Date
I would like my paternity leave (and SPP if applicable) to start on the date the baby is born/the child is placed for adoption:
*
Yes
No
If no, the date you would like your paternity leave to start:
*
Duration of paternity leave:
*
One Week
Two Weeks
Choose decleration
*
Natural and non-adopted children: I would like to take paternity leave and to receive SPP if I qualify for it. I confirm that I meet each of the eligibility criteria as follows:• I have, or will have, responsibility for the child’s upbringing• I am either the biological father of the child, or I am married to or in a civil partnership with the child’s mother, or I am living with the child’s mother in an enduring family relationship but I am not an immediate relative of the mother• I am making this request for time off work to care for the child or to support the child’s mother• I have worked continuously as an employee of the Company for 26 weeks by the week that falls 15 weeks before the week in which the child is/was expected to be born.
Adopted children: I would like to take paternity leave and to receive SPP if I qualify for it. I confirm that I meet each of the eligibility criteria as follows:• I have, or will have, responsibility for the child’s upbringing• I am adopting the child jointly with my spouse/partner and I want to receive paternity leave and SPP not adoption leave and statutory adoption pay, or I am married to or in a civil partnership with the person adopting the child, or I am living with the person adopting the child in an enduring family relationship but I am not an immediate relative of the adopter• I am making this request for time off work to care for the child or to support the person adopting the child/the primary adopter• I have worked continuously as an employee of the Company for 26 weeks up to and including the week I/the adopter was told by the adoption agency that I/they had been matched with the child.
Signature
*
Date
*
-
Day
-
Month
Year
Date
Continue
Continue
Should be Empty: