PERMISSION FORM
To be completed by University of Warwick employee
Name:
Employee number:
National insurance number:
The start date of my statutory maternity pay period was:
I intend to return to work from my maternity leave on:
I confirm that ___________________________ (name) is my child’s father and/or my husband,
partner or civil partner
In addition I confirm that ___________________________ (name) has, or expects to have, the main
responsibility (apart from my responsibility) for the upbringing of my child
___________________________ (name) is, to my knowledge, the only person exercising the
entitlement to additional paternity leave, and is the sole applicant for additional statutory paternity pay,
in respect of my child
I consent to the University of Warwick giving the relevant information to my husband/partner/
civil partner’s employer in order for them to take additional paternity leave.
Signed:
Dated:
Notes
A partner is a person, whether of a different sex or the same sex, who lives with the mother and the
child in an enduring family relationship but is not a relative of the mother. A "relative" for these
purposes includes the mother’s parents, grandparents, sisters, brothers, aunts and uncles.
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PERMISSION FORM To be completed by University of Warwick employee