Paternity Leave Request Letter - Template, Sample Form

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Dear Sir/Madam,

RE: Notice of Intention to Take Statutory Paternity Leave and Pay
Employee Name: ________
Payroll/Staff Reference Number: ________
National Insurance Number: ________

§ 1. Purpose of this notice. I am writing in accordance with my entitlement to ordinary statutory paternity leave and statutory paternity pay under the Employment Rights Act 1996, the Paternity and Adoption Leave Regulations 2002 (SI 2002/2788, as amended) and the Statutory Paternity Pay and Statutory Adoption Pay (General) Regulations 2002 (SI 2002/2822, as amended). This letter constitutes the statutory notice that I am required to give you of my intention to take paternity leave and to receive statutory paternity pay and/or any contractual paternity pay provided for in my contract of employment.

§ 2. Eligibility. I confirm that:

1. I am the biological father of the child, or the spouse, civil partner or partner (including same-sex partner) of the mother or of a person who is to adopt the child;
2. I have, or expect to have, the main responsibility (together with the mother or co-adopter) for the upbringing of the child;
3. I will have been continuously employed by you for a period of not less than 26 weeks ending with the relevant week (the 15th week before the expected week of childbirth); and
4. I am taking the leave for the purpose of caring for the child or supporting the child's mother.

§ 3. Expected week of childbirth. The child is expected to be born in the week beginning ________. The relevant date for the purposes of these arrangements is ________.

§ 4. Amount of leave requested. I wish to take ________ of paternity leave. I understand that statutory paternity leave may be taken either as a single week or as two consecutive weeks and must be taken as a whole week or weeks (and not as odd days).

§ 5. Date leave is to begin. I should like my paternity leave to begin on ________ (for example, on the date of the child's birth, a specified number of days after the birth, or a specified date). I confirm that my leave will begin no earlier than the date of the child's birth and that all leave will be completed within 56 days of the actual date of birth (or, if the child is born before the expected week of childbirth, within 56 days of the first day of the expected week of childbirth).

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§ 8. Protection of employment. I note that I am entitled to return to the same job on the same terms and conditions following my paternity leave, and that I am protected from suffering any detriment or dismissal by reason of having taken or sought to take paternity leave, pursuant to the Employment Rights Act 1996 and the Paternity and Adoption Leave Regulations 2002.

§ 9. Confirmation requested. Please confirm in writing, within 28 days of receipt of this notice, that you have received this notification and that my paternity leave and pay have been approved, together with details of the period of leave, the start and end dates and the pay payable. Should you require any further information or documentation, please do not hesitate to contact me.

Yours faithfully,



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Signature: ________
Date: ________