Letter Requesting Parental Leave - Template Form Pro · IN-law

FROM:

________
(Employee)

Designation: ________
Employee ID: ________
Department: ________
Residential Address: ________

TO:

________
Designation: ________
________
Registered Office: ________

Dated: ________

Re: Application for Maternity Leave and Maternity Benefit under the Maternity Benefit Act, 1961 (as amended by the Maternity Benefit (Amendment) Act, 2017)

Dear ________,

§ 1. Purpose of the Application

Further to the discussion held on ________, during which you were kind enough to indicate your in-principle concurrence, I am writing to formally apply for maternity leave and the corresponding maternity benefit in accordance with the provisions of the Maternity Benefit Act, 1961 (as amended), and the prevailing leave and maternity benefit policy of ________.

§ 2. Period of Leave Requested

I hereby request you to sanction maternity leave for a period of ________ commencing from ________ and ending on ________. I expect to resume my duties on ________.

I confirm that I have completed not less than eighty (80) days of work in the establishment during the twelve (12) months immediately preceding the expected date of my delivery, as required under Section 5(2) of the Maternity Benefit Act, 1961, and am accordingly eligible for the benefits claimed herein.

§ 3. Expected Date of Delivery

I am presently in the advanced stage of pregnancy and my expected date of delivery, as certified by my registered medical practitioner, is on or before ________. The leave applied for is within the maximum entitlement permissible under Section 5 of the said Act and is consistent with the Company's maternity leave policy.

§ 4. Claim for Maternity Benefit

In terms of Sections 5 and 6 of the Maternity Benefit Act, 1961, I request that the maternity benefit at the rate of the average daily wage be paid to me in advance for the period preceding my delivery, that is, from ________ up to and including the expected date of delivery, namely ________, and that the balance amount be paid within forty-eight (48) hours of production of proof of delivery, in accordance with Section 6(5) of the Act.

I further confirm my entitlement to the medical bonus and other ancillary benefits, if any, payable under the Act and/or the Company's policy.

§ 5. Documents Enclosed

In support of this application, I enclose the following:

1. Medical certificate from a registered medical practitioner certifying the pregnancy and the expected date of delivery;
2. Notice and declaration in the form prescribed under Section 6 of the Maternity Benefit Act, 1961;
3. Nomination of the person to whom payment of the maternity benefit may be made in the event of my absence, namely ________;
4. Such other documents as may be required: ________.

§ 6. Delegation of Duties

During the period of my absence, the duties, projects and responsibilities entrusted to me shall be delegated to ________, and I shall endeavour to ensure that no exigency arises on account of my leave.

§ 7. Contact During Leave

In the event of any urgent matter, I may be reached on telephone number ________; should I be unavailable, a message may be left and I shall revert at the earliest opportunity. I may also be contacted by electronic mail at ________. It is, however, respectfully submitted that, in accordance with Section 4(4) of the Maternity Benefit Act, 1961, I shall not be required to perform work of an arduous nature during the protected period.

§ 8. Assurance of Smooth Transition

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§ 9. Request for Confirmation

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I thank you for your kind consideration.

Yours sincerely,

________

Signature: _________________

Date: ________

Place: ________

Acknowledgement of Receipt (For Office Use)

Received on: ________
Name & Signature of Authorised Officer: ________