Language
English (UK)
Bulgarian
Română
Polski
Russian
Italiano
Maternity Leave Plan Form
This plan covers your statutory rights to maternity leave and statutory maternity pay (SMP). You do not have to fill in this plan to benefit from the right to maternity leave and SMP, but you do have to give the Company most of the information it contains. You may therefore wish to use this plan as a straightforward way of making sure you give the Company all the necessary information so that you can take maternity leave and receive SMP if you qualify for it. Once you have completed the plan, you should immediately forward it to HR and you should keep a copy for your own records.
Telling the Company that you are pregnant.You can tell us that you are pregnant assoon as you want to. This can be before you have decided when to take maternityleave. You will, of course, need to tell us if you want to take paid time offfor antenatal appointments. The latest date you can inform us of your pregnancyis the 15th week before your expected week of childbirth (EWC).Telling the Company when you want to take maternityleave.You must have told us by the 15th weekbefore your EWC when you want to start your maternity leave and begin toreceive SMP. This should be in writing. If you are using this plan for thispurpose, you need to give it to us at the latest during the 15th week beforeyour EWC. If you later wish to change the date on which you will start yourmaternity leave, you must give us at least 28 days’ notice of yourproposed revised start date.Statutory Maternity Leave & Statutory MaternityPay (SMP)As well as qualifying for maternity leave,you may also qualify for SMP. If you do not qualify for SMP, you may be able toclaim maternity allowance (MA) from your local Jobcentre Plus.How to use the planThe plan is in three parts. Complete PartA first, followed by Part B. Use Part C only if you wish to return to workbefore you have taken your full maternity leave entitlement. Brief notes aregiven in the right-hand column.You will be expected back at the end ofyour full maternity leave entitlement. You are due back on the date you put forquestion 3 of Part B. If you want to return earlier, you must give the Companyat least eight weeks’ advance notice. This does not have to be in writing, butyou may like to use this part of the plan to let us know.
Name
*
First Name
Last Name
Company Name
*
I am pregnant
*
Yes
No
My baby is due in the week beginning:
*
-
Month
-
Day
Year
The expected week of childbirth is the week, beginning Sunday, in which it is expected you will have your baby.
A MATB1 certificate confirming this..
*
Has been given to you already
Is enclosed within this form
Will be given to you shortly
Maternity Leave
I intend to start my maternity leave on:
*
-
Month
-
Day
Year
Start date: it is your decision when you start your maternity leave, but you cannot start it earlier than the eleventh week before your EWC. You must notify us of your intended start date in the 15th week before the EWC. My maternity leave will run for up to 52 weeks.
My maternity leave will finish on:
*
-
Month
-
Day
Year
Date
I am due back to work on:
*
-
Month
-
Day
Year
Date
Signature
*
Date
*
-
Month
-
Day
Year
Date
Continue
Continue
Should be Empty: