PL: REQUEST FOR PATERNITY LEAVE

This form must be completed no later than 28 days before you wish your paternity leave to start

Name / Staff No
School / Job Title
Home Address
Tel:
Email Address
Date commenced continuous employment with Wandsworth
Date commenced continuous Local Government service

Please tick the appropriate box:

I am the child’s father, who has or expects to have responsibility for upbringing the child: /
I am either the husband of the expectant mother or partner, who expects to have the main responsibility for the upbringing of the child: /
Please indicate the dates that you wish to take maternity support leave to and from (one / two weeks) / From: To:

You must attach a copy of the mother’s MATB1 certificate to this form.

MOTHER’S SIGNATURE…………………………………………..Date: …………………..

EMPLOYEE SIGNATURE………………………………………...Date: …………………..

NOTE TO SCHOOL

  • The entire period of paternity leave must be taken within 56 days of the child’s birth.
  • Paternity leave can only be taken in blocks of one or two weeks.

Authorised Manager:
Signed:______
Print Name:______
Job Title:______
Date: / Authorised Payroll Signature:
Signed:______
Print Name:______
Date:______

Please send the original copy of this form together with a copy of the MATB1 directly to Payroll.

If the employee who is requesting paternity leave is a teacher, a copy of this form and the MATB1 should

be sent to Janet Marshall, Contracts, HR and School’s Support, Wandsworth Town Hall, Wandsworth High Street, London, SW18 2PU.

There is no need to send this form to your HR Officer.

PLA: REQUEST FOR PATERNITY LEAVE – ADOPTION

To apply for paternity leave you must complete this form and return it to your Headteacher/Line Manager no later than 7 days after the date on which the adopter is notified of having been matched with a child.Only one period of paternity leave may be taken in the case of more than one child being placed with the adopter as part of the same arrangement.

Name / Staff No
School / Job Title
Home Address
Tel:
Email Address
Date commenced continuous employment with Wandsworth
Date commenced continuous Local Government service

ADOPTION AND LEAVE DETAILS

The adoption agency to told the person adopting the child that they have been matched with the child on (insert date)
The child is expected to be placed on (insert date)
And, if the child has been placed, please enter the date they were placed.
Please indicate the dates that you wish to take paternity leave to and from (one / two weeks) / From: To:

Please tick the appropriate box

I am married tothe person adopting the child and expect to have responsibility for the upbringing of the child. /
I am the partner (a person whether of a different or the same sex, who lives with the adopter and the child in an enduring family relationship but is not the adopter’s mother parent, grandparent, sister, brother aunt or uncle), of the child’s adopter and have or expect to have the main responsibility (apart from the adopter’s responsibility) for the upbringing of the child. /

You must provide evidence of the adoption match (i.e. a matching certificate).

Employee’s Signature:Date:

______

Adopters Signature:Date:

______

Adopters Name:Date:

______

Note to School

  • The entire period of paternity leave must be taken within 56 days of the day the child is placed with the adopting parent.
  • Paternity leave can only be taken in blocks of one or two weeks.

Authorised Manager Signature:Date:

______

Name/Job Title:Date:

______

Authorised Payroll Signature:Date:

______

Name / Job Title:

______

Please send this form and a copy of the matching certificate directly to payroll.

If the employee who is requesting paternity leave for adoption is a teacher, a copy of this form and the MATB1 should be sent to Janet Marshall, Contracts, HR and School’s Support, Wandsworth Town Hall, Wandsworth High Street, SW18 2PU.

There is no need to send this form to your HR Officer.

APL: APPLICATION FOR ADDITIONAL STATUTORY

PATERNITY PAY (ASPP) / ADDITIONAL PATERNITY

LEAVE (APL)

To apply for ASPP or APL you must complete this form and return it to your Headteacher/Line Manager at least 8 weeks before you intend to take additional paternity leave.

Name: / Staff No.
School: / Post:
Permanent Fixed Term Temporary Supply Please tick appropriate box
Grade / Hours / Week
Local government continuous service / Date from:
Expected Date of Confinement / Date:
Child’s date of birth / Date:
I would like my ASPP* to start on: / Date:
Date my ASPP is expected to end: / Date:
I would like my APL** to end on: / Date:
* ASPP = Additional statutory paternity pay / ** APL = Additional Parental Leave
Declaration:
I declare that I will care for the child during the ASPP period; and
I am the child’s father or I am the spouse, partner or civil partner of the mother, and
expect to have, the main responsibility (apart form the mother) for the
upbringing of the child, and
I have enclosed a photocopy of the child’s birth certificate and understand that if
my application form is sent without this information it will be returned.
The information I have provided is correct and I have not fraudulently nor
negligently provided incorrect information or made a false statement or declaration.
Signature……………………………….Date……………………….

DETAILS OF THE MOTHER OF THE CHILD - (TO BE COMPLETED BY THE MOTHER OF CHILD)

Full Name:
NI Number:
Home address
Tel:
Email address:
Employer’s Name and Address
Tel:
Email.
Date your SMP* or MA** pay started / Date:
Date you intend to return to work / Date:
Date you stopped or intend to stop receiving SMP* or MA / Date:
* SMP = Statutory Maternity Pay / ** MA = Maternity Allowance
Declaration of the mother of the child:
You will need to be able to tick all the boxes for your spouse, partner or civil partner to get ASPP
I am entitled to SMP or MA
This is the only application of ASPP for this child
I have told my employer the date I expect to return to work
I consent to the information I have provided being processed by the school
The information I have provided is correct and I have not fraudulently
nor negligently provided incorrect information or made a false statement or
declaration.
Signature……………………………….Date……………………….

Manager Signature:______Date ______

Name ______Job Title ______

Authorised Payroll Signature:______Date ______

Name ______Job Title ______

Please ensure that all areas of this form have been fully completed and that that a copy of the child’s birth certificate is enclosed before sending this form to payroll. The school must send a memo to payroll once the employee has returned to work.

There is no need to send this form to your HR Officer.

MSL: REQUEST FOR MATERNITY SUPPORT LEAVE

To apply for maternity support leave you must complete this form and return it to your Headteacher/Line Manager at least 28 days before the date when you wish to commence maternity support leave. The date will be based on the expected week of childbirth (EWC).

Name / Staff No
School / Job Title
Home Address
Tel:
Email Address

DETAILS OF LEAVE

Please indicate the dates that you wish to take maternity support leave to and from. / From: To:
Name of Expectant Mother
Relationship to Expectant Mother
Signature of Expectant Mother
If a carer has been nominated other than the partner or father please fill in the declaration below:
I ……………………………..(name of nominated carer) confirm that I will be the primary provider at or around the time that ………………………………..(name of expectant mother) gives birth. If I am not granted maternity support leave it is likely to have a bearing on my well-being and work performance because: ………………………………………………………………………………………………………
………………………………………………………………………………………………………

A copy of the MATB1 must be attached to this form

SIGNED:………………………………………………………….. DATE…………………………………..

NOTE TO SCHOOL - Only five days leave shall be granted.

Manager Signature:______Date ______

Name ______Job Title ______

Authorised Payroll Signature:______Date ______

Name ______Job Title ______

The original copy of this form and MATB1 should be sent direct to Payroll.

If the employee who wishes to take the Maternity Support Leave is a teacher, a copy of this form and MATB1 should be sent to Janet Marshall, Contracts HR and School’s Support, Wandsworth Town Hall, Wandsworth High Street, SW18 2PU.

There is no need to send this form to your HR Officer.
PL1: REQUEST FOR PARENTAL LEAVE

This form needs to be completed and sent to your line manager no later than 21 days before you wish to commence parental leave.

Name / Staff No
School / Job Title

I wish to apply for parental leave from …………… to…………….. as discussed with my line manager.

Name of child
Age of child
I am the child’s named parent on the birth certificate / Yes No Please tick
If you are not the named parent on the birth certificate please confirm which of the categories set out below you fall into
A father who was married to the mother at the time of birth
A parent who has acquired parental responsibility under the Children Act 2004
A guardian appointed under section 5 of the Children Act 2004
An adoptive parent
I confirm that my purpose in requesting leave is for caring for my child. / Yes No
Are you employed by any other department within the Council / Yes No
If you answered yes to the above question please provide details of the department / section and name of your Manager.
Please provide details of how many days / weeks parental leave with Wandsworth and / or previous employers.

Please submit a copy of the birth certificate(s) attached to this form or proof; or other proof of entitlement to parental leave. If your child is in receipt of disability allowance, proof of this is also required.

SIGNED………………………………………………………DATE……………………

NOTE TO SCHOOL

There is no need to send this form back to Children’s Services HR. However, any leave taken must be marked as unpaid on the school’s absence returns.

Please consider the following:

  • The amount of leave, which can be taken is restricted to four weeks per child per year.
  • Leave can only be taken in blocks or multiples of one week.
  • Parents of disabled children can take their leave in blocks or multiples of one day rather than one week.
  • The employee must give at least 21 days notice of any proposed period of parental leave unless the employee gives notice to take the leave immediately after the child is born or adopted.

Authorised Manager Signature:Date:

______

Name / Job Title:

______

Authorised Payroll Signature:Date:

______

Name / Job Title:

______