Application for Adoption Leave (Surrogacy) Form

Please use this online form to notify the HR Employment Support Services Team of your application for adoption leave (surrogacy).

Your Details

Name*
Email*
Payroll Number*
School/Department*
Home Address*

Country*

Postcode*
 

Address*


Town*

Details of Adoption Leave (Surrogacy)

Please accept this notification as my application for adoption leave (Surrogacy).

I wish to begin my leave on:*
Baby's due date is:*
I agree to send to the HR Department (hr@nottingham.ac.uk) a copy of the parental order as soon as I have obtained this document (within 6 months of the commencement of adoption leave).
 
I understand that if I choose to return earlier than the first working day after 52 weeks’ adoption leave I have to give at least 8 weeks’ written notice of my intention to return to work to the HR Department.
 
I understand that I should take annual leave in the standard annual leave year, and I will book this annual leave with my line manager in the usual manner.
 
I understand that should I wish to resign from my employment with the University during my adoption leave, I must give the University written notice in accordance with my contract of employment.
 
I understand that if I receive payment under the Enhanced University Adoption Scheme it is subject to me:
  • returning to work for a minimum of 3 months following adoption leave, and
  • providing a copy of the parental order within 6 months of the baby’s birth.
If I am unable to fulfil this requirement I understand I will be required to repay any entitlements received in excess of the statutory pay.

Evidence of my parental responsibility

Please upload the following document(s) as evidence of your parental responsibility:

File Upload - MAT B1 Form*

Valid upload file types: .doc .docx .pdf
The total size of all files on the form cannot be more than 10 MB
File Upload - Copy of parental order (within 6 months of commencement of adoption leave)

Valid upload file types: .doc .docx .pdf
The total size of all files on the form cannot be more than 10 MB

Pension

Please select as appropriate:*




Note: for members of the NHS pension scheme there is a requirement to make pension contributions during unpaid adoption leave. Arrangements will be made to repay the full employee contribution for the unpaid adoption leave period on return to work.
 
I would like (subject to scheme rules allowing this) on my return to work to repay the employee pension contribution for any unpaid adoption leave so that my membership is continuous.
Please select:

Line Manager Approval

I can confirm that I have discussed this application for adoption leave (Surrogacy) with my line manager and he/she has agreed the dates stated above.*

Line Manager's Name*
Comments*
Verification*