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Request for Family Medical Leave - Template Form Pro · NG-law

✓ Valid in Nigeria · drafted to comply with local law

Create your Request for Family Medical Leave - Template Form for use in Nigeria. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.

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Request for Family Medical Leave - Template Form
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________
________
Employee Identification/Staff Number: ________
Designation/Department: ________

________

________
(The Human Resources Manager / Head of Department)
________

Dear Sir/Madam,

RE: FORMAL APPLICATION FOR FAMILY/COMPASSIONATE LEAVE

I write further to the conversation we held on ________ concerning my request for leave from my employment with ________ ("the Company"), and pursuant to the terms of my contract of employment dated ________, the Company's Staff Handbook/Leave Policy, and the applicable provisions of the Labour Act, Cap. L1, Laws of the Federation of Nigeria 2004.

§ 1. Particulars of the Application
I respectfully apply for family/compassionate leave for a period of ________ in order to care for my spouse/relative, who is presently unwell. The relationship of the said person to me is that of ________.

§ 2. Duration of Leave
The leave is expected to commence on ________ and to conclude on ________, after which I undertake to resume my duties without delay.

§ 3. Supporting Documentation
In support of this application, and in accordance with the Company's policy, I enclose herewith a medical certificate dated ________ issued by ________ evidencing the need for the leave applied for. I confirm that the personal and medical information contained therein is provided solely for the purpose of processing this application, and I request that it be handled in accordance with the Nigeria Data Protection Act 2023.

§ 4. Continuity of Work and Handover
To ensure minimal disruption to the operations of the Company during my absence, I have made or am willing to make arrangements for the handover of my responsibilities to ________ or to such other officer as the Company may direct.

§ 5. Contact During Leave
Should any urgent matter arise during the period of my leave, I may be reached by telephone on ________ or by electronic mail at ________.


Yours faithfully,




__________________
________
Signature & Date: ________

Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.