Additional Paternity Leave Application

Additional Paternity Leave ApplicationCHRIS/72

This form is for use where you wish to apply for Additional Statutory Paternity Pay (ASPP) because your spouse, civil partner or partner has given birth or because you have jointly adopted from within the UK and (in either case) your spouse, civil partner or partner is returning to work. You have to give this completed form to your department at least eight weeks before you want to start your leave. We will confirm your entitlement to ASPP within four weeks of receiving your application.

Details of the University’s paternity leave policy are available online at the following address. Alternatively, contact your departmental administrator for assistance.

Please complete this form in BLOCK CAPITALS.

PART 1 – Application for Leave

To be completed by the employee

Section A – Personal Details and employment

These questions must all be answered. Your personal reference number can be found on your payslip.
Questions 6 and 7: it is very important that we know what days of the week you are working in order that we can calculate your leave entitlement correctly. In question 7, tell us the start date of this pattern (even if in the past). If your pattern changes before you go on leave, you must tell us. / 1. Surname
2. Forenames
3. Personal Reference Number
4. Position Held
5. Faculty / Department
6. Working pattern
Every weekday Monday-Friday
Specified below
Mon / Tue / Wed / Thu / Fri / Sat / Sun
7. Start date of this pattern (if known)

Section B – Details of leave requested

8. Is the child adopted?
Yes / No
9. Expected date of birth (or date of notification by adoption agency)
10. Actual date of birth (or date of placement for adoption)
11. Start date of leave
12. End date of leave

Section C – Details of the mother or adopter

13. Surname
14. Forenames
15. Address
16. Mother / adopter’s National Insurance number
17. Start date of maternity / adoption payment
18. End date of maternity / adoption payment
19. Date mother / adopter returned to work

Section C – Declarations of applicant and of mother/adopter

Applicant

I am applying for Paternity Leave in order to support the mother/person adopting the child or to care for the child. The information included in this application is correct.I declare that:

Tick
I am the child’s biological father or I am married to the mother or I am living with the mother in an enduring family relationship as partner (but not a relative of the mother)or I have been jointly matched for adoption with my spouse, civil partner or partner, who has taken adoption leave to care for the child
I have/will have responsibility for the child’s upbringing
I am adopting a child with my partner and I want to receive Statutory Paternity Pay and paternity leave, not Statutory Adoption Pay and adoption leave
I will care for the child during the Additional Paternity Leave period

Signed(applicant)Date

Adopter/mother

I declare that:

Tick
I am entitled to Statutory Maternity Pay or Maternity Allowance or Statutory Adoption Pay
This is the only application for additional paternity pay for this child
I have told my employer the date I expect to return to work
I agree that the information I have provided will be used by the applicant’s employer to work out entitlement to ASPP
The information I have provided is correct

Signed(adopter / mother)Date

Now send this form to your Departmental Administrator

Part 2 – Institutional Acknowledgement

To be completed by the institution

Leave noted (signature of Head of Institution or authorised deputy)

Signed Name

Position Date

This form should now be sent to your HR School Team Administrator at the relevant address:

Old Schools / AddenbrookesHospital
School of Arts & Humanities / School of Clinical Medicine
School of the Biological Sciences
School of the Humanities & Social Sciences
School of the Physical Sciences
School of Technology
UAS
Non-School Institutions

Part 3 – For HUMAN RESOURCES Use

To be completed by the Human Resources Division

If the answer to 20 is “No”, state the reason in question 21. / 20. Employee qualifies for ASPP
Yes / No
21. Comments

SignedName

PositionDate

Now make the proper updates on the CHRIS system.

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