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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 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.

  • Answer 19 simple questions - the document fills in as you go
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Below you can preview the Request for Family Medical Leave, complete it by answering a few plain-English questions, and download a ready-to-sign copy in Word and PDF — tailored for use in Nigeria.

What the Request for Family Medical Leave includes

This template is organised into the following sections:

Frequently asked questions

What is a Request for Family Medical Leave?

A Request for Family Medical Leave is a ready-to-use legal template for Nigeria. You complete it by answering a few plain-English questions, then download the finished document in Word and PDF.

What does the Request for Family Medical Leave cover?

The Request for Family Medical Leave is organised into sections covering RE: FORMAL APPLICATION FOR FAMILY/COMPASSIONATE LEAVE, § 1. Particulars of the Application, § 2. Duration of Leave, § 3. Supporting Documentation, § 4. Continuity of Work and Handover, so the important points are captured in a clear, consistent structure.

What formats can I download?

You can download your completed Request for Family Medical Leave as an editable Microsoft Word (.docx) file and as a PDF.

Can I edit the document later?

Yes — save it to your account and you can re-open, edit and re-download it at any time.

Prepared and reviewed by the LegalDocs team.

Document preview

________
________
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: ________

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