Maternity Leave Application Form Page 2
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1
2Lead Employer Trust use only:
Full Pay:
__________ weeks
Up to 8 weeks
Half Pay:
__________ weeks
Up to 18 weeks
Entitlement:
SMP:
__________ weeks
Up to 39 weeks
Unpaid:
__________ weeks
Up to 52 weeks
Maternity leave dates:
From:
To:
Annual leave dates:
From:
To:
Return to work date:
Date letter sent:
Date Intrepid updated:
Date payroll informed:
Signature: *
Date: *
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Parent category: Business