APPLICATION FOR ADDITIONAL STATUTORY
PATERNITY LEAVE (ASPL) / ADDITIONAL STATUTORY
PATERNITY PAY (ASPP) – Becoming an adoptive parent
This form can be made available in large print and alternative formats, where required, on
request from the Equal Opportunities Unit, tel: 02890 973039.
Please submit this completed form to the Equal Opportunities Unit. Additional paternity leave
/ additional paternity pay can only be authorised when the completed form has been
received.
Section 1 – Applicant Arrangements and Details
I wish to commence my ASPL on:
I wish my ASPL to end on:
I wish to commence by ASPP* on:
My ASPP is expected to end on:
*Entitlement to ASPP will be assessed by the University’s salaries office
I was informed by the adoption agency that I
had been matched with a child on:
The child was placed on:
(dd/mm/yyyy)
(dd/mm/yyyy)
(dd/mm/yyyy)
(dd/mm/yyyy)
(dd/mm/yyyy)
(dd/mm/yyyy)
HOLIDAY ENTITLEMENT – Please indicate if you wish to add any holiday entitlement
to the end of your additional paternity leave period.
I wish to add
days holiday leave entitlement to the end of my additional paternity
leave period.
My holiday leave will commence on:
(dd/mm/yyyy)
My holiday leave will end on:
(dd/mm/yyyy)
Note: A member of staff is expected, where possible, to take their full annual leave
entitlement in a particular leave year. However, should this not be possible due to additional
paternity leave arrangements or exceptional circumstances, he/she will be able to carry over
up to the full complement of leave (42 days) to the next leave year, the scheduling of which
must be taken by arrangement with the Head of School/Department/Unit.
I DECLARE THAT I AM ELIGIBLE FOR ADDITIONAL PATERNITY LEAVE / PAY AS
OUTLINED IN THE UNIVERSITY’S PROCEDURE
Staff number:
Full name: (PRINT)
Position:
School/Department/Unit:
Staff category (e.g. Academic,
Clerical)
Applicant’s signature:
Date:
Section 2 –Details of the joint adopter of the child:
To be completed by the adopter of the child who applied for statutory adoption pay
(SAP) :
Full Name
Address
Post code
My SAP or AA pay period commenced on:
(dd/mm/yyyy)
I intend returning to work on:
(dd/mm/yyyy)
I stopped / intend to stop receiving SAP or AA on: (dd/mm/yyyy)
My national insurance number is:
You will need to be able to tick all the boxes below for your spouse, partner or civil partner to
get ASPP
 I am entitled to SAP or AA
 This is the only application of ASPL and ASPP for this child
 I have told my employer the date I expect to return to work
 I agree that the information I have provided will be used by the University
to work out entitlement to ASPL and / or ASPP
 The information that I have provided is correct
Mother’s signature:
Date:
PLEASE
ENSURE
THAT
YOU
HAVE
ADVISED
YOUR
HEAD
OF
SCHOOL/DEPARTMENT/UNIT OF THE DETAIL OF YOUR APPLICATION BEFORE
SUBMITTING THE FORM TO THE EQUAL OPPORTUNITIES UNIT
The original application will be transferred to the Personnel Department to be retained on the
individual’s personnel file. A copy will also be forwarded to the Finance Department.
The University is committed to promoting equality of opportunity for all staff irrespective of
their sex, marital status, perceived religion, political opinion, racial group, sexual orientation,
age, having a disability or having dependants.
The information contained on this application form will be used in conjunction with
information already held on the Equal Opportunities Unit’s database to monitor the take-up of
and the impact of the University’s work life balance/family friendly arrangements and the
implementation of its equal opportunities policy.
The information relating to the request will be held on an Equal Opportunities database for a
period of five years. After this time if data is retained it will be anonymised.
For Official Use Only
Date received by Equal Opportunities Unit
Database entry
Date forwarded to Salaries Office:
Date received by Personnel Department