Maternity Leave Form - DOC - DOC by ro2Qcqg

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									MATERNITY LEAVE FORM
Please complete the relevant sections of this form and pass to your line manager for their information and
signature. Once completed, the form should then be forwarded to the Human Resources Division, together with
the certificate giving the expected date of confinement (Mat B1). This form will confirm the arrangements agreed
between the member of staff and line manager in respect of the maternity leave and is for School and Directorate
use only. For further information on the Maternity Leave Scheme, please refer to Work Life Balance on the Human
Resources web pages.

Full Name:                                                                      Staff Number:

                                                                                School/Directorate
School/Directorate:
                                                                                Contact Details:


Home Address



Please tick the Maternity Leave Scheme you wish to apply for:


Option 1 (no entitlement to pay of any kind):
                                                                                                                              1
All female staff, regardless of length of service and                   52 weeks Statutory Maternity Leave (SML)
earnings received
Option 2 (entitled to Statutory but not University                      Statutory Maternity Pay (SMP) for 39 weeks:
Pay):
                                                                        90% of your average weekly pay for the first six weeks
                                                                                          2
Female staff who have 26 weeks’ continuous service                      and either £128.73 or 90% of your average weekly
with the University at the end of the 15th week before                  earnings (whichever is lower) for the remaining 33 weeks.
the expected week of confinement (EWC) and have
                                                                        This may be followed by 13 weeks of unpaid leave.
paid National Insurance contributions on their
earnings
Option 3 (entitled to University Maternity Pay):                        18 weeks at full pay (inclusive of SMP), plus
Female staff with 12 months’ continuous service at                      8 weeks at half pay (inclusive of SMP), plus
the EWC and who intend to return work in a full or
                                                                        13 weeks at Statutory Maternity Pay rate
part time capacity for a minimum of 13 weeks after
completion of their maternity leave                                     This may be followed by 13 weeks of unpaid leave.


Option 4 (entitled to University Maternity Pay but                      Statutory Maternity Pay (SMP) 39 weeks -
decide to forego it):
                                                                        90% of your average weekly pay for the first six weeks
Female staff who decide at any time prior to the birth                  and either £128.73 or 90% of your average weekly
of their baby that they will not be returning to work.                  earnings (whichever is lower) for the remaining 33 weeks.



1
  For female staff not entitled to receive SMP, they may be entitled to receive Maternity Allowance from their local Social Security office or Job Centre Plus. Where
relevant, this is paid directly to the individual by the Department of Social Security.
2
    This rate is determined each April by the Department of Work and Pensions and will increase wef April 2012.
      Key Dates:

      Expected Week of Confinement: NB Your
      maternity certificate (MatB1) must be attached
      to this form
      Planned start date of maternity leave:

      Unpaid leave to be taken:                                           From:                             To:
                                                   3
      Anticipated date of return to work (prior to any
      accrued annual leave being taken):
      Use of accrued Annual Leave:                                        Total number of annual
                                                                          leave days accrued:
      Annual leave will continue to accrue at the normal rate
      during the period of maternity leave. The accrued leave             Annual leave to be taken          From:           To:
      must be used in conjunction with the maternity leave. Any           prior to the start of maternity
      carry over of annual leave to another leave year should
                                                                          leave:
      be limited to 5 days unless permission has been granted
      by the Head of School / Directorate to increase this in line        Number of annual leave
      with the Flexible Use of Annual Leave scheme and,                   days remaining:
      again, must be used in conjunction with the maternity
      leave.                                                              Annual leave to be taken          From:           To:
      Statutory days will only accrue during periods of unpaid            following the maternity
      leave or when a member of staff is only in receipt of the           leave:
      Statutory Maternity Pay element of maternity pay.

      Other use of Annual Leave:
                                                                          If applicable, please give details of your plans to use your
      Annual leave can be used flexibly to create a further               accrued annual leave:
      period of paid leave following the end of a period of paid
      or unpaid absence or, with the permission of the Head of
      School/Directorate, to have a phased reduction in working
      hours prior to the commencement of leave or following a
      return.




      I hereby agree that the Maternity Leave granted to me by Cardiff University shall be governed by the Employment
      Act 2004 and the Social Security Act 1986. In accepting Option 3 of the Maternity Leave Schemes, I undertake to
      continue in the service of Cardiff University, either in my present post or an alternative, for a minimum of 13 weeks
      after the expiry of my maternity leave, If I fail to return to work, I will be liable to return all maternity pay received,
      except any Statutory Maternity Pay to which I am entitled. I ALSO GIVE CARDIFF UNIVERSITY AUTHORISATION
      TO CONFIRM WITH AN EXTERNAL EMPLOYER THE DETAILS OF MY MATERNITY LEAVE FOR THE PURPOSES OF
      STATUTORY ADDITIONAL PATERNITY LEAVE AND PAY, IF APPROPRIATE. THIS WILL ONLY NEED TO BE DONE
      WHERE THE PERSON APPLYING FOR SUCH LEAVE DOES NOT WORK FOR THE UNVERSITY.

      Signed by Member of                                                                    Date:
      Staff:
      Signed by the Line                                                                     Date:
      Manager to confirm
      knowledge of the leave:


3
    It is a statutory requirement to take a minimum of 2 weeks Maternity Leave

								
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