Maternity Leave Application Form

Please use this online form to notify HR of your application for maternity leave.

Please complete this form by the 15th week before the expected week of childbirth. You may, if you wish, change your commencement date provided you give either a) in the case of delaying a start date, 28 days' written notice before the date previously notified, or b) in the case of bringing it forward, 28 days' written notice before the new start date.

Your Details

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

Country*

Postcode*
 

Address*


Town*

Line Manager's Name*

Maternity Leave Details

I wish to notify you that I am pregnant and wish to make an application for maternity leave.

Please upload a copy of your MAT B1 Certificate*

Valid upload file types: .doc .docx .pdf
The file cannot be more than 10 MB in size
My expected date of childbirth is (as on MAT B1 form):*
I wish to begin my maternity leave on:*
I will inform the University of the date on which my baby is born, as soon after the birth as is practicable.
 
If I wish to return to work on my first working date after 52 weeks' maternity leave, I am aware that I do not have to give the University any notice of my return to work.
 
If I wish to return to work earlier, or later (if eligible), than the first working day after 52 weeks' maternity leave, I am aware that I must give the Human Resources Department at least 8 weeks' notice.
 
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 maternity 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 Maternity Scheme (other than Statutory Maternity Pay) it is subject to me returning to work for a minimum of 3 months following maternity leave.
 
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.

Pension

Please select as appropriate:*




Note: For members of the NHS Pension Scheme, there is a requirement to make pension contributions during unpaid maternity leave. Arrangements will be made to repay the full employee contribution for the unpaid maternity 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 maternity leave so that my membership is continuous.

Please Select:

Parking

I confirm that I do not wish to continue contributing to my car parking payments during any unpaid maternity leave. Employees must (re)join the scheme on return from maternity leave if return is in a new car parking year (ie September annually).

Please Select:
Please Select:

Car Benefit Scheme

Please Select:*

Note: If I am a member of the scheme, I understand that the University will send a copy of my Matb1 form (or equivalent) to Tusker to enable a claim through the protection insurance.

Annual Leave Purchase Scheme

Please Select:

Career Break

Career Break - please select one of the following options:*
Further Information
Verification*