Paternity Leave Request - Template, Sample Form

________
________
________
________
________

________

________
________
________
________

Re: Application for Paternity Leave under Republic Act No. 8187

Dear ________,

I, ________, presently employed with ________ as ________ since ________, with Employee Number ________, respectfully write to formally apply for paternity leave in connection with the pregnancy and forthcoming delivery of my lawful spouse, ________.

§ 1. Statutory Basis. This application is made pursuant to Republic Act No. 8187, otherwise known as the “Paternity Leave Act of 1996,” and its Implementing Rules and Regulations, which entitle every married male employee in the private sector to a paternity leave of seven (7) calendar days with full pay, consisting of basic salary and mandatory allowances fixed by the Regional Wage Board, for the first four (4) deliveries of his legitimate spouse with whom he is cohabiting.

§ 2. Period of Leave. I respectfully request that my paternity leave commence on ________ and end on ________, covering a total of seven (7) calendar days. I understand that, conformably with law and company policy, this leave may be enjoyed before, during, or immediately after the delivery, provided that it is availed of not later than sixty (60) days from the date of said delivery.

§ 3. Compliance with Conditions. I respectfully certify that I have satisfied all the conditions for entitlement under Republic Act No. 8187, namely:

1. I am lawfully married to and presently cohabiting with my spouse, ________, our marriage having been solemnized on ________ at ________;
2. This claim pertains to the ________ delivery of my spouse, which is within the first four (4) deliveries as required by law;
3. The expected date of delivery is on ________; and
4. This notice is being given within a reasonable time prior to the expected date of delivery, in accordance with the reasonable notice rule under the law and the company’s leave policy.

§ 4. Purpose of Leave. The paternity leave herein applied for shall be devoted to lending support to my spouse during her period of recovery and/or in the nursing of our newborn child, consistent with the purpose of the law.

§ 5. Supporting Documents. In support of this application, I attach the following:

1. A medical certificate duly issued by my spouse’s attending physician, ________, evidencing the fact of pregnancy and indicating the expected date of delivery as ________;
2. A copy of our Marriage Certificate issued by the Philippine Statistics Authority; and
3. Such other documents as may be required, namely ________.

I undertake to submit, in due course, a copy of the child’s Certificate of Live Birth or other proof of delivery, should the same be required to complete the processing of this application.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla.

You may reach me at ________ or at ________. Should I be unreachable during the period of my leave, I shall be pleased to attend to any matter requiring my attention immediately upon my return to work.

Thank you for your kind consideration and favorable action on this application.

Very truly yours,

________
________

Received by:

________
________
Date Received: ________