Shared Parental Leave form ref: SPL3B

Declaration to Accompany a Father/Secondary Adopter’s

Notice of Entitlement

This form is for a mother or primary adopter to declare their eligibility for Shared Parental Leave in support of the notice being submitted by the father, mother’s partner or secondary adopter.

Note to completer: once you’ve filled this in, please give it to your partner/ the child’s father (i.e. the employee of the University) so it can be submittedto the University alongside their Notice of Entitlement. NB. You do not need to submit this form to your own employer. Your employer should have their own forms which you are required to complete in order to take Shared Parental Leave.

Section 1: My details

My name:
My address:
Name and address of my employer:
My national insurance number OR confirmation that I do not have a national insurance number:
Section 2: My statement
I confirm that:
  1. I satisfy the employment and earnings criteria* that allow [insert name of University of Salford employee] to accessShared Parental Leave.
  2. Together with [insert name of University of Salford employee] I have the main responsibility for the care of the child.
  3. A) I am entitled to statutory maternity leave, statutory maternity pay or statutory maternity allowance in respect of our child and I have either returned to work or curtailed my maternity leave or maternity pay or maternity allowance period (and that period remains curtailed).
OR
B) I am entitled to statutory adoption leave, statutory adoption pay or statutory adoption allowance in respect of our child and I have either returned to work or curtailed my adoption leave or adoption pay or adoption allowance period (and that period remains curtailed).
  1. I will immediately inform [insert name of University of Salford employee] if I decide torevoke my decision to curtail my maternity/adoption leave, maternity/adoption pay or maternity/adoption allowance period.
  2. I consent to [insert name of University of Salford employee] taking the amount of leave set out in his/her Shared Parental Leave Notice of Entitlement.
  3. I consent to you processing the information contained in this declaration for the purposes of [insert name of University of Salford employee]’sapplication forShared Parental Leave.

Print Name and Sign:
Date:

*See Shared Parental Leave Policy for information.

Declaration to accompany a Father/Adopter’s Notice of Entitlement Page1 of2

Human Resources, March15 V1