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Shared Parental Leave Form A: For the colleague taking maternity/adoption leave to complete Section 1 Complete section 1 if you want to bring your maternity/adoption leave (and pay) period to an end early. My manager
I would like to bring my maternity/adoption leave (and pay) period to an end after
weeks on
I understand that it’s not normally possible for me to cancel this notice once it has been given. TICK I HAVE COMPLETED THIS FORM AS I AM ENTITLED AND INTEND TO TAKE SHARED PARENTAL LEAVE AS DETAILED BELOW
I CONFIRM THAT MY PARTNER HAS GIVEN THEIR EMPLOYER NOTICE OF THEIR INTENTION TO TAKE SHARED PARENTAL LEAVE AND THAT I AGREE WITH THE AMOUNT OF SHARED PARENTAL LEAVE THAT MY PARTNER IS INTENDING TO TAKE
I DO NOT INTEND TO TAKE SHARED PARENTAL LEAVE
Section 2 Complete section 2 if you are entitled to and wish to take Shared Parental Leave I am writing to let you know that I am eligible for, and that my partner and/or I intend to take, a period of Shared Parental Leave. The information below confirms my entitlement to take Shared Parental Leave My name
My partners name
My maternity/ adoption leave started on:
/
/
My maternity/ adoption leave ended/will end on:
/
/
My child’s due date (the date on my MatB1):
/
/
My child’s date of birth/date of placement:
/
/
Number of weeks maternity/ adoption leave taken:
1
The total amount of Shared Parental Leave (in weeks) available to me and my partner is: 52 MINUS MATERNITY/ADOPTION LEAVE TAKEN
=
The total amount of Statutory Shared Parental Pay (in weeks) available to me and my partner is: 39 MINUS MATERNITY/ADOPTION PAY RECEIVED
=
I intend to take this many weeks’ Shared Parental Leave and Pay: My partner intends to take this many weeks’ Shared Parental Leave and Pay:
I confirm that: I satisfy the following eligibility criteria for Shared Parental Leave or I will have satisfied them by the time I take leave: TICK I HAD BEEN EMPLOYED FOR 26 WEEKS BY THE TIME I WAS 25 WEEKS’ PREGNANT / AT THE END OF THE WEEK THE ADOPTION AGENCY NOTIFIED ME OF A MATCHING DATE AND I WILL REMAIN WORKING FOR TESCO UNTIL MY FIRST PERIOD OF SHARED PARENTAL LEAVE I HAVE THE MAIN RESPONSIBILITY FOR THE CARE OF MY CHILD WITH THE CHILD’S DAD/MY PARTNER I HAVE REDUCED MY PERIOD OF MATERNITY/ADOPTION LEAVE OR HAVE RETURNED TO WORK BEFORE THE END OF MY MATERNITY/ADOPTION LEAVE MY NORMAL WEEKLY EARNINGS IN THE 8-WEEK PERIOD ENDING WITH THE 15TH WEEK BEFORE MY CHILD’S DUE/PLACEMENT DATE WERE NOT LESS THAN THE LOWER EARNINGS LIMIT (CURRENTLY £111 PER WEEK) I INTEND TO CARE FOR THE CHILD DURING EACH WEEK THAT I AM RECEIVING SHARED PARENTAL PAY I HAVE PROVIDED ANY ADDITIONAL EVIDENCE REQUESTED
The information given in this form is accurate and I will inform you immediately if I cease to care for my child or if I cease to be eligible to take Shared Parental Leave or claim Statutory Shared Parental Pay. I enclose Form C from my partner providing the further information required from them.
Section 3 Complete section 3 to notify Tesco of the specific periods of Shared Parental Leave you wish to take Leave notice
Additional details
THE START AND END DATES OF EACH PERIOD OF SHARED PARENTAL LEAVE I INTEND TO TAKE:
THE START AND END DATES OF WHEN I WOULD LIKE TO RECEIVE STATUTORY SHARED PARENTAL PAY:
START
START
END
END
SIGNATURE
DATE
/
/
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