Appendix D
FORMS
Maternity/Adoption
Shared Parental Leave
Paternity Leave
Ordinary Parental leave
Maternity/ Adoption leave
Entitled to Statutory pay
Not entitled to Statutory pay
APPLICATION FOR MATERNITY/ADOPTION LEAVE
(Entitled to Statutory* Maternity/ Adoption pay)
*To qualify you must have been employed for 26 weeks at the 15th week before the expected week of
childbirth
Personal Details
Surname:
Forenames:
Email:
Tel no:
UCL Employee Number:
UCL Department / Division
Line Manager:
Post ID:
Please tick as appropriate:
I enclose my original MAT B1/adoption matching certificate
YES
NO
I wish to return to work following my maternity/adoption leave
YES
NO
CONFIRMATION OF MATERNITY/ADOPTION LEAVE PERIOD
My expected week of
…………………………….
childbirth/placement
is
the
week
commencing
Sunday
I wish my maternity/adoption leave to commence on: …………………………………...............
I wish to take my maternity/adoption leave as follows (please tick the appropriate boxes):
18 weeks full pay and 21 weeks SMP
9 weeks full pay, 18 weeks half pay plus 21 weeks SMP
You are entitled to take up to an additional 13 weeks unpaid maternity/adoption leave
I wish to take …………… weeks/days (delete as appropriate) unpaid maternity/adoption leave
following my period of paid leave.
My proposed date of return to work (if applicable) is……………………...
You will resume on your normal rate of pay on this date. If you wish to take outstanding annual
leave at this point you should agree the dates with your manager in the usual way.
If you wish to convert any of the above paid/unpaid maternity/adoption leave and pay into
shared parental leave and pay, please read the policy and fill in the following forms. You will
need to give at least 8 weeks’ notice if bringing your maternity/adoption leave to an end and
starting any shared parental leave.
End of Maternity/adoption leave form
Entitlement and Intention to Commence Shared Parental Leave
Period of Leave Notice
KEEPING IN TOUCH DAYS
You are entitled to request up to 10 Keeping in touch (KIT) days, which must be agreed with
your line manager.
Any time spent on a KIT day (in multiples of one hour) should be taken as TOIL on your return,
as agreed with your line manager.
Contact on Leave:
My contact address whilst on maternity/adoption leave is:
………………………………………………………………………………………………………….
……………………………………………………………Post code ……………………………….
Email: …………………………………………………… Tel no: ……………………………..
Further details on parental leave entitlements can be found at:
https://www.ucl.ac.uk/hr/docs/parental-leave.php
Should you have any queries regarding your maternity/adoption leave entitlements, please
contact the HR ECA Supervisor for your department or alternatively speak to your
departmental administrator.
_
I confirm that my attention has been drawn to the right of UCL to reclaim the whole or part of
the non-statutory element of maternity/adoption pay if I fail to return to work and continue in
employment for at least three months.
SIGNED: …………………………………………
DATE: …………………………
PLEASE PASS TO YOUR LINE MANAGER FOR COUNTERSIGNING
_
TO: LINE MANAGER
The above is eligible for statutory maternity/adoption pay, 92% is reclaimed from the Inland
Revenue by UCL, which will not be charged to your departmental or grant funds.
The employee is also eligible for UCL maternity/adoption pay totalling 18 weeks leave with full
pay and 21 weeks Statutory Maternity Pay (SMP) (or 9 weeks full pay and 18 weeks half pay
plus 21 weeks SMP) on the understanding that s/he returns to work for a minimum of 3 months
after her/his leave.
If her/his appointment is funded by a grant and the grant expires during the period of paid
maternity/adoption leave, on a fixed term contract or otherwise made redundant but the
employee is otherwise eligible for UCL maternity/adoption pay, then UCL maternity/adoption
pay will be paid until the last day of service. SMP/SAP will be paid in total, even where this
goes beyond the last day of service. Remember that it is important to fully consult with your
employee should any such changes occur whilst they are on leave.
The employee is eligible to 52 weeks of maternity/adoption leave in total which comprises
of: 39 weeks of UCL and statutory maternity leave and 13 weeks of additional unpaid
maternity/adoption leave.
The employee can also request the use of up to 10 keeping in touch days (see section
above) in which they can undertake work, training or attend meetings. This will not extend
the total maternity leave period. There is no obligation on the employee or UCL to make use
of these days. Employees will be given time off in lieu for any keeping in touch days worked.
Annual leave accrues throughout the maternity/adoption leave period. It is your
responsibility to agree any annual leave or TOIL in lieu of KIT days on the employee’s
return. Please note you should only grant equivalent TOIL for actual hours worked on a KIT
day.
Please sign below indicating your approval of the above.
SIGNED: ……………………………………. NAME: ……………………………………….
DATE: …………………………
Please pass promptly to your ECA Supervisor
HUMAN RESOURCES (to complete):
Name:……………………………………….Signed……………………………………….
Date:......................................................................
PAYROLL (to complete):
Name:.........................................................Signed………………………………….
Date:……………………………………………..
Mat Leave Proform Completed:
Pension Scheme:
USS
NHS
SAUL
APPLICATION FOR MATERNITY/ADOPTION LEAVE
(NOT entitled to Statutory* Maternity/ Adoption pay)
*To qualify you must have been employed for 26 weeks at the 15th week before the expected week of
childbirth
Personal Details
Surname:
Forenames:
Email:
Tel no:
UCL Employee Number:
UCL Department / Division
Line Manager:
Post ID:
Please tick as appropriate:
I enclose my original MAT B1/adoption matching certificate
YES
NO
I wish to return to work following my maternity/adoption leave
YES
NO
CONFIRMATION OF MATERNITY/ADOPTION LEAVE PERIOD
My expected week of
…………………………….
childbirth/placement
is
the
week
commencing
Sunday
I wish my maternity/adoption leave to commence on: …………………………………...............
I wish to take my maternity/adoption leave as follows (please tick the appropriate boxes):
18 weeks full pay plus up to 34 weeks’ unpaid leave
9 weeks full pay, 18 weeks half pay plus up to 25 weeks’ unpaid leave
I wish to take …………… weeks/days (delete as appropriate) unpaid maternity/adoption leave
following my period of paid leave.
My proposed date of return to work (if applicable) is……………………...
You will resume on your normal rate of pay on this date. If you wish to take outstanding annual
leave at this point you should agree the dates with your manager in the usual way.
If you wish to convert any of the above paid/unpaid maternity/adoption leave and pay into
shared parental leave and pay, please read the policy and fill in the following forms. You will
need to give at least 8 weeks’ notice if bringing your maternity/adoption leave to an end and
starting any shared parental leave.
End of Maternity/adoption leave form
Entitlement and Intention to Commence Shared Parental Leave
Period of Leave Notice
KEEPING IN TOUCH DAYS
You are entitled to request up to 10 Keeping in touch (KIT) days, which must be agreed with
your line manager.
Any time spent on a KIT day (in multiples of one hour) should be taken as TOIL on your return,
as agreed with your line manager.
Contact on Leave:
My contact address whilst on maternity/adoption leave is:
………………………………………………………………………………………………………….
……………………………………………………………Post code ……………………………….
Email: …………………………………………………… Tel no: ……………………………..
Further details on parental leave entitlements can be found at:
https://www.ucl.ac.uk/hr/docs/parental-leave.php
Should you have any queries regarding your maternity/adoption leave entitlements, please
contact the HR ECA Supervisor for your department or alternatively speak to your
departmental administrator.
_
I confirm that my attention has been drawn to the right of UCL to reclaim the whole or part of
the non-statutory element of maternity/adoption pay if I fail to return to work and continue in
employment for at least three months.
SIGNED: …………………………………………
DATE: …………………………
PLEASE PASS TO YOUR LINE MANAGER FOR COUNTERSIGNING
_
TO: LINE MANAGER
The employee is eligible for UCL maternity/adoption pay totalling 18 weeks leave with full pay
or 9 weeks full pay and 18 weeks half pay on the understanding that s/he returns to work for
a minimum of 3 months after her/his leave.
If her/his appointment is funded by a grant and the grant expires during the period of paid
maternity/adoption leave, on a fixed term contract or otherwise made redundant but the
employee is otherwise eligible for UCL maternity/adoption pay, then UCL maternity/adoption
pay will be paid until the last day of service. Remember that it is important to fully consult with
your employee should any such changes occur whilst they are on leave.
The employee is eligible to 52 weeks of maternity/adoption leave in total.
The employee can also request the use of up to 10 keeping in touch days in which they can
undertake work, training or attend meetings. This will not extend the total maternity/adoption
leave period. There is no obligation on the employee or UCL to make use of these days.
Employees will be given time off in lieu for any keeping in touch days worked.
Annual leave accrues throughout the maternity/adoption leave period. It is your
responsibility to agree any annual leave or TOIL in lieu of KIT days on the employee’s
return. Please note you should only grant equivalent TOIL for actual hours worked on a KIT
day.
Please sign below indicating your approval of the above.
SIGNED: ……………………………………. NAME: ……………………………………….
DATE: …………………………
Please pass promptly to your ECA Supervisor
HUMAN RESOURCES (to complete):
Name:……………………………………….Signed……………………………………….
Date:......................................................................
PAYROLL (to complete):
Name:.........................................................Signed………………………………….
Date:……………………………………………..
Mat Leave Proform Completed:
Pension Scheme:
USS
NHS
SAUL
Shared Parental leave
End of Maternity/Adoption Leave
Entitlement and Intention to take Shared Parental Leave
Period of Leave Notice
Period of Leave (Variation) Notice
UCL HUMAN RESOURCES DIVISION
Form END1
Shared Parental Leave
Notification to End Maternity/Adoption Leave
Please complete the details below to confirm that you propose to bring to an end your
maternity/adoption leave and pay and start a period of Shared Parental Leave. You must
give at least 8 weeks’ notice.
Once this form has been submitted, you will receive confirmation of your intention plus the
relevant forms to complete to provide details of how you wish to take your shared parental
leave, if not already submitted.
Please note this notice is BINDING if given after the birth or adoption. If given before the
birth or adoption you may withdraw this notice in writing up to 6 weeks after the birth or
adoption date, as long as you have not returned to work or the end date already passed.
Personal Details
Surname:
Forenames:
Email:
Tel no:
UCL Employee Number:
UCL Department / Division
Line Manager:
Confirmation of Maternity / Adoption Leave and Pay Period
Please confirm the start and end date of your maternity leave and pay period.
Please note: the end date of the maternity leave period must allow for the 2 week
compulsory maternity leave period immediately following the birth.
Start Date of Maternity / Adoption Leave:
End Date of Maternity/Adoption Leave:
End date of SMP/SAP:
Expected week of childbirth:
Date of birth / date of adoption (where appropriate):
Details:
Please provide brief details of how you intend to take your shared parental leave and who
this will be shared with.
Declaration:
Please sign below to confirm that your intention to end your maternity leave period and start
an application for Shared Parental leave.
Employee (Mother/Primary Adopter) Signature:
Dated:
Received and noted:
Line Manager:
Dated:
Please forward a copy to your Departmental Manager/Administrator and pass to your
ECA Supervisor promptly.
Employment Contract Administration Team:
UCL HUMAN RESOURCES DIVISION
Form: ShPL E&I
Shared Parental Leave
Entitlement and Intention to Take Shared Parental Leave
Please complete the details below confirming your intention to take Shared Parental Leave.
Please ensure that a ‘Notification to End Maternity/Adoption Leave’ form has either already
been submitted or is submitted with this form. This form may be designed for a different
organisation if the mother/primary adopter is not a UCL employee.
UCL Employee Personal Details
Surname:
Forenames:
Email:
Tel:
UCL Employee Number:
UCL Department / Division
Line Manager:
Partners Details: Please confirm the details of the individual with whom the parental leave
will be shared with:
Surname:
Forenames:
Home Address:
NI number:
Employer’s* Details:
(please state if self-employed)
Name of Employer:
Address of Employer:
Contact Name at present employer (e.g. Line Manager or HR):
Email address for Contact
Telephone number for contact:
Please note: UCL may contact your partner’s employer to confirm the requested period of
Shared Parental Leave.
UCL Employee Confirmation of Entitlement:
I confirm that (please tick as appropriate):
I have 26 weeks service at the15th week before the expected week of childbirth
(EWC) (for statutory purposes)
The total amount of shared parental leave available is..….. weeks (52 weeks minus any
maternity or adoption leave already taken, including 2 weeks compulsory leave).
As relates to the mother or primary adopter:
Start Date of Maternity/Adoption Leave:
End Date of Maternity/Adoption Leave:
End date of SMP/SAP:
Expected week of childbirth:
Date of birth / date of adoption (where appropriate):
If not already submitted, please attach a copy of the child’s birth certificate, adoption matching
certificate or MATB1 (if before the child is born) and a copy of the end of maternity/adoption
form
UCL Employee Commencement of Shared Parental Leave:
I wish to exercise my right to shared parental leave as follows:
Start date of shared parental leave:
End date of shared parental leave:
Intended date of return to work:
UCL Employee Declaration:
I confirm that both my partner and I meet the qualification requirements to take Shared
Parental Leave (including the employment and earnings test) and we are sharing childcare
responsibilities.
I will immediately inform HR (ECA Team) should I cease to meet the conditions of eligibility.
Please tick this box if your partner is the mother or primary adopter:
I consent to the amount of leave that my partner intends to take and that I will
immediately inform him/her should I cease to meet the conditions for eligibility.
Employee Signature:
Dated:
Partner’s Declaration:
I confirm that I meet the requirements for Shared Parental Leave (including the employment
and earnings test) and by signing this declaration consent for you to contact my employer for
any confirmation required.
Please tick this box if your partner is the mother or primary adopter:
I consent to the amount of leave that my partner intends to take and that I will
immediately inform him/her should I cease to meet the conditions for eligibility.
Partners Signature:
Dated:
Received and noted:
Line Manager:
Dated:
Please forward a copy to your Departmental Manager/Administrator and pass to your
ECA Supervisor promptly.
Employment Contract Administration Team:
UCL HUMAN RESOURCES DIVISION
Form: PLN
Shared Parental Leave
Period of Leave Notification
Please complete the details below confirming your intention to take a period of Shared
Parental Leave.
UCL Employee Personal Details
Surname:
Forenames:
Email:
Tel:
UCL Employee Number:
UCL Department / Division
Line Manager:
Confirmation of Entitlement:
I confirm that my partner and I continue to be entitled to take shared parental leave,
as previously declared.
Start Date of Maternity/Adoption Leave:
End Date of Maternity/Adoption Leave:
End date of SMP/SAP:
Expected week of childbirth:
Date of birth / date of adoption (where appropriate):
Requested Period of Shared Parental Leave:
Please note that to request or change any period of leave, 8 weeks notification must be
given.
You may request up to 3 periods of leave in this notice and be entitled to enhanced shared
parental pay. If this form is submitted following the birth and you subsequently vary this
notice or submit a new notice, you will forfeit any right to enhanced pay and will receive only
statutory pay.
The first start date may be an actual date or expressed as the number of days from the date
of the birth or adoption, if this notice is given before the birth or adoption. Please remember
to promptly confirm the actual date of birth to your ECA Supervisor so they can effect
the changes.
I will take the following period/s of Shared Parental Leave (please note this should be in
blocks of whole weeks):
Start date
End date
Start date
End date
Start date
End date
No of
weeks
Running total
of weeks
No of
weeks
Running total
of weeks
Intended final date of return to work:
My partner will be taking shared parental leave as follows:
Start date
End date
Start date
End date
Start date
End date
Details:
Please provide any additional details in relation to your shared parental leave, including the
sharing of pay if, for example, you are taking leave at the same time:
Declaration:
Employee Signature:
Dated:
Received and approved:
Line Manager:
Dated:
Please forward a copy to your Departmental Manager/Administrator and pass to your
ECA Supervisor promptly.
Employment Contract Administration Team:
UCL HUMAN RESOURCES DIVISION
Form: PLN(V)
Shared Parental Leave
Period of Leave Variation Notice
Please complete the details below confirming your intention to take a period of Shared
Parental Leave.
UCL Employee Personal Details
Surname:
Forenames:
Email:
Tel:
UCL Employee Number:
UCL Department / Division
Line Manager:
Confirmation of Entitlement:
I confirm that my partner and I continue to be entitled to take shared parental leave,
as previously declared.
Requested variation to shared parental leave:
Please note to change any period of leave, 8 weeks of notification must be given.
By submitting this variation request, you will forfeit any right to enhanced pay and will receive
only statutory pay.
I intend to vary my period of Shared Parental Leave and to take it as follows:
No of
weeks
Start date
End date
Start date
End date
Start date
End date
Intended final date of return to work:
My partner will be taking shared parental leave as follows
Running
total of
weeks
No of
weeks
Start date
End date
Start date
End date
Start date
End date
Running
total of
weeks
Details:
Please provide any additional details in relation to your shared parental leave, including the
sharing of pay if, for example, you are taking leave at the same time:
Declaration:
Employee Signature:
Dated:
Received and approved:
Line Manager:
Dated:
Please forward a copy to your Departmental Manager/Administrator and pass to your
ECA Supervisor promptly.
Employment Contracts Administration Team
Paternity/Partners Leave
CONFIRMATION OF PATERNITY/PARTNER’S LEAVE
Personal Details
Surname:
Forenames:
Email:
Tel no:
UCL Employee Number:
UCL Department / Division
Line Manager:
Please indicate as appropriate:
I enclose a copy of the MAT B1/adoption matching certificate
I enclose a copy of the birth/adoption placement certificate
CONFIRMATION OF PATERNITY LEAVE PERIOD
If taking paternity leave before the birth/adoption:
The expected week of childbirth/adoption placement is ………………………………………..
*The dates of my paternity leave will be. ………………………………………………………...
If taking paternity leave after the birth/adoption (please send after the actual
birth/placement):
The actual date of birth/placement was ………………………………………………………….
*The dates of my paternity leave were: ….. ………………………………………………………...
*COMPULSORY FIELDS
_
DECLARATION
You must be able to tick all three boxes below to receive ordinary paternity leave and pay.
I declare that:

I am
- the baby’s biological father, or
- married to or in a civil partnership with the mother, or
- living with the mother in an enduring family relationship,
but am not an immediate relative, and

I will have responsibility for the child’s upbringing, and

I will take time off work to support the mother or care for the child.
SIGNED: …………………………………………
DATE: …………………………
Please contact the HR ECA Supervisor for your department for any queries regarding your
paternity leave entitlements. Further details on paternity leave entitlements can be found at:
https://www.ucl.ac.uk/hr/docs/parental-leave.php
TO: LINE MANAGER
The above is entitled to four weeks paid paternity leave.
Please sign below indicating your approval of the above.
SIGNED: ……………………………………. NAME: ……………………………………….
DATE: ………………………………………..
The form should be returned to HR ECA Team within 1 week of the employee taking
Paternity Leave.
Employment Contracts Administration Team
Ordinary Parental Leave
REQUEST FOR ORDINARY PARENTAL LEAVE
Personal Details
Surname:
Forenames:
Email:
Tel no:
UCL Employee Number:
UCL Department / Division
Line Manager:
Background Information
First day of service with UCL: ………………………………………………
Date of birth/placement of the child/children: ………………………………………..
This is the first request for ordinary parental leave
If this is your first request, please attach a copy of the birth or placement certificate
I have previously taken ordinary parental leave
(including with a previous employer) as follows:
From: ………………………………. To: ……………………………
From: ……………………………….. To: ……………………………
From: ……………………………….. To: ……………………………
Leave Request
This can be taken in blocks of one week (maximum of four weeks in any one year) at any time
up to the child’s 18th birthday.
I request the following unpaid ordinary parental leave (please note you must give at least 21
days’ notice):
From: ………………………………. To: ……………………………
_
DECLARATION
You must be able to tick all three boxes below to receive ordinary parental leave.
I declare that:
I have at least one year qualifying service with UCL
I have parental responsibility for the child/children
I'm requesting unpaid parental leave to look after the child’s/children’s welfare
SIGNED: …………………………………………
DATE: …………………………
Please contact the HR ECA Supervisor for your department for any queries regarding your
ordinary parental leave entitlements. Further details on ordinary parental leave can be found
at: https://www.ucl.ac.uk/hr/docs/parental-leave.php
LINE MANAGER
You may agree to the above request or require the employee to postpone OPL for a period
of up to six months, if the needs of the service require you to do so. Exceptions to this
requirement may be where the leave is triggered by the birth or adoption of a child, or when
it is requested immediately following a period of ML, AL, ShPL or PL. Factors which may
require you to request the postponement of OPL could include the need to:



avoid clashing with a peak workload or holiday period;
take into account the absence of colleagues;
find a way in which the work of the employee can be covered.
I agree to the above request for ordinary parental leave
I request a postponement of the request until the following dates
From: ………………………………. To: ……………………………
SIGNED: ……………………………………. NAME: ……………………………………….
DATE: ………………………………………..
Please return this form to your ECA Supervisor promptly.
Employment Contracts Administration Team