Contact Email/Tel No

FIN/SPL – Sept 2017

/ SHARED PARENTAL LEAVE
(SPL) & (MATERNITY/ADOPTION)
NOTIFICATION FORM

This form is for University of Sheffield staff to provide notification of an upcoming period of Maternity/Adoption and SPL.
Please read the Maternity/Adoption and SPL Policy and Procedure, available via the HR Family Leave website at the following link: before completing this form.
Please complete this form by the 15th week before the expected week of childbirth (EWC) and send it, fully signed, to; Payroll, Firth Court, Western Bank, Sheffield, S10 2TN, or in person to Level One Reception, Arts Tower, Western Bank, Sheffield, S10 2TN.
Please attach your MATB1 Certificate or Matching Certificate to this form before sending to Payroll, as this is needed to confirm the EWC before payroll can perform the necessary calculations.

1. Your details - Please complete all the fields using CAPITAL LETTERS

FIN/SPL – Sept 2017

Full Name

FIN/SPL – Sept 2017

Department

Preferred

Contact Email/Tel No:

Employee/Payroll No: MATB1/Matching Certificate Attached

(Mandatory)

2. Your partners details - Please complete all the fields using CAPITAL LETTERS

Full Name

Employer (Name and
Address)

NI Number
3. Which Maternity/Adoption Leave scheme do you wish to apply for, in advance of your Shared Parental Leave? / Please tick one
box below 
Option A / University Scheme - 39 Weeks paid leave option
Option B / Statutory Maternity/Adoption Leave ONLY with SMP for a maximum period of 39 weeks
Option C / Maternity Allowance

FIN/SPL – Sept 2017

4. Key Dates - Please use the on-line calculator to complete this section. Please advise Payroll as soon as possible if these anticipated dates change.
1 / Expected Week of Childbirth (EWC) - this starts from the Sunday before the date in which your baby is due to be born: / dd/mm/yy
2 / Date notified by the adoption agency that a match was made (or date of official notification for an overseas adoption) (or in the case of intended parents of a child born through a legal surrogacy arrangement the EWC):
Date the child is expected to be placed on/was placed on (or entered the UK): / dd/mm/yy
dd/mm/yy
3 / Expected date that you wish your Maternity/Adoption Leave to start - this can start on any day of the week: / dd/mm/yy

FIN/SPL – Sept 2017

5. Shared Parental Leave
I wish to exercise my right to take Shared Parental Leave. My dates of leave are (this date must be after the compulsory 2 week maternity/adoption leave period).
Start date / End date / No. Weeks
Total Number of Weeks:
Please list the dates your partner will be taking Shared Parental Leave:
Start date / End date / No. Weeks
Total Number of Weeks:
Please note: : the combined amount of shared parental pay cannot exceed 37 weeks (not including compulsory 2 weeks maternity/adoption leave period) and the amount of leave cannot exceed 50 weeks.
I intend to return to work following Shared Parental Leave on:
Please do not include the dates of your annual leave here (if you are taking some on your return). Please see Section 6 of the SPL Procedure for further information. / dd/mm/yy

I confirm that:

1 / The information provided above is correct.
2 / I understand that if I receive payment under the Enhanced Maternity/Adoption/SPL scheme (other than Statutory Maternity/Adoption/SPL pay) it is subject to me returning to work for a minimum of three months following the maternity/adoption/SPL leave period.
If I am unable to fulfil this requirement I am aware that the University reserves the right to reclaim the non-statutory element of the maternity/adoption/SPL pay.
3 / I understand that should I seek to take annual leave in the standard leave year, I will book this in the usual manner. (Carrying over annual leave may be possible, subject to agreement with your line manager).
4 / I can confirm I will curtail my maternity/adoption leave as per Section 5 as I will be sharing leave with my partner.
5 / Where it is identified that a staff member has provided false information or a false declaration e.g. regarding their own or their partner’s eligibility, the leave taken by their partner etc., this will be classed as gross misconduct and will addressed under the disciplinary procedure. Where fraudulent activity is found the University reserves the right to reclaim any payments received from the University or state that the staff member was not entitled to (as well as advise the state accordingly).
Signature
(Employee)

Signature
(Partner)
Signed by
Line Manager
Requests for discontinuous periods of SPL will require consideration within 2 weeks of the request being submitted. Further advice should be sought from your HR Team contact.
Please note: by signing this form you are agreeing to the leave pattern suggested in Section 5.