Newcastle University – Unpaid Leave Request Form
TITLE:
Preferred first name:
Personnel no:
Forename(s):
Surname:
(as shown on passport)
(as shown on passport)
Academic/Service Unit:
Email address:
Extension:
Home address:
Contact no:
Postcode:
The University will provide a period of unpaid leave. In return your annual salary will be
reduced by an amount equivalent to the number of days leave being taken.
You must apply giving your line manager at least 2 months notice of the date you wish
to start your unpaid leave.
I wish to apply for a period of unpaid leave From ____/_____/____ to ____/____/____
The reason from my request is: (please give details)
Declaration:
I confirm that, if approved, my salary will stop on the first day of my leave
and restart when I return to work.
For members of a pension scheme:
I understand that the period of unpaid leave will not be pensionable and will be counted as
suspended service. For the USS pension scheme a payment can be made to cover death
in service/ill-health retirement for the period of the unpaid leave. For the RBP pension
scheme this is not necessary.
For members of USS pension scheme: Please tick if you wish to pay the contribution
detailed:
I wish to make an additional contribution to the pension scheme for
death in service/ill-health retirement cover.
Signed:
Date:
Approved / not approved by: (please delete one)
Manager:
Signature:
Date:
Print name:
Once completed, this form should be sent to your Faculty/Services HR team.
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Unpaid Leave Request Form
Form updated 05 August 2011