SPL9 - Mother's Declaration Form

Please use this online form to notify HR of your application as a mother to accompany the father's notice of entitlement to take Shared Parental Leave (SPL).

Your Details

Name*
Email Address*
Name of University of Nottingham Employee*
School/Department of University of Nottingham Employee*
Name of the Child*
In submitting this form I confirm that:
  • I satisfy the employment and earning criteria that allows the named employee access to SPL.
  • Together with the employee named above I have the main responsibility for the care of the above named child.
  • I am entitled to statutory maternity leave/pay/allowance in respect of the named above child and I have either returned to work or curtailed my period of maternity leave/pay/allowance (and that period remains curtailed).
  • I will immediately inform the above named if I decide to revoke my decision to curtail my maternity leave, maternity pay or maternity.
  • I consent to the employee named above taking the amount of leave set out in the SPL notice of entitlement.
  • I consent to you (the employer) processing the information contained within the declaration for the purposes of the named employee's application for SPL and in accordance with good data protection principles.

I set out below the further information I am required to give you:

My Address*

Country*

Postcode*
 

Address*


Town*

My National Insurance Number (or I can confirm I do not have a NI Number)*
File Upload - Partner's notice of entitlement and intention to take Shared Parental Leave*

Valid upload file types: .doc .docx .pdf
The file cannot be more than 10 MB in size
Comments*
Verification*