Section 1: Employee Details

Name / MMU ID
Department

Section 2: Pregnancy Details

Where you are not yet able to provide details, insert TBA and provide the details when you are able.

The expected week of my childbirth (EWC) is

Please attach proof of pregnancy (MATB1) with this form or submit when you have it.

Section 3: Maternity Leave Details

I wish my maternity leave to begin on

The date above should be the first day you will be absent from work, excluding any period of annual leave. Remember:

  • You may commence maternity leave any time after the beginning of the 11th week before the EWC, the latest date being the date of birth itself;
  • To advise us of this date as soon as reasonably practical, but at least 28 days before the start of your maternity leave;
  • If your maternity leave starts before the planned date, for example due to childbirth or illness, you need to notify us as soon as reasonably practical;
  • Should you give birth early, you need to notify us of the date of childbirth.

My last day of maternity leave will be on

Remember:

  • You may finish maternity leave any time between 2 and 52 weeks after the birth;
  • If you intend to return to work earlier than this date, you must notify us at least 8 weeks before your intended return date.

The day after my maternity leave finishes I wish to take the following number of hours entitlement that I have accrued.

At which point:

I intend to return to work on

OR

I do not intend to return to work, and my last day of service will be

If, after the maternity leave has ended, you or your partner wish to take up shared parental leave, or you wish to take unpaid parental leave, please read the relevant policies and discuss with your line manager.

Section 4: Agreement

I undertake to comply with the requirements of the University's maternityleave policy.

Print Name / Employee Signature / Date
Print Name / Manager Signature / Date

Please send a copy of this form to the employee and to the Human Resource Department:

HR Business Solutions
4th Floor All Saints Building
Manchester
M15 6BH

If sending to HR by email, please send to .