Application For Maternity Leave Form (Ml1)

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Application for Maternity Leave Form (ML1)
COLLEAGUE DETAILS
Business
Colleague name
Employee number
Start date
MATERNITY DETAILS (To be completed by the colleague)
I give notice of my absence due to pregnancy or childbirth
MATB1 certificate
Yes
Maternity Leave to start on
.…../..……/….
enclosed
I participate in the Co-op
Childcare Vouchers Salary
Yes
No
Expected Week
Sacrifice Scheme
of Childbirth
.…../..…/….…
(EWC)
I participate in the Co-op
Pension Salary Sacrifice
Yes
No
Scheme
NOTES
th
-
Maternity Leave can’t start before the 11
week before expected week of childbirth.
If you change your mind about when you want to begin your Maternity Leave after
-
you’ve completed this form, you must give your manager at least 28 days’ written notice
before the new date when you want your leave to start or the original start date
(whichever is the earliest), or as soon as you can if this isn’t practically possible.
Maternity Leave will begin automatically if you’re absent because of illness for a
-
pregnancy-related reason in the four weeks before the expected week of childbirth.
If your baby arrives early, and before you’ve begun your Maternity Leave, your
-
Maternity Leave period will start from the week of the birth. You should tell your
manager as soon as possible and confirm this in writing.
Colleague’s
Date
signature
Manager’s
Date
signature
Please give this form, together with your MATB1 certificate, to your manager who will
send them to HR Services.
Registered Office: Co-operative Group Limited, 1 Angel Square, Manchester M60 0AG. Reg No 525R. Registered in England and Wales.

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