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APPLICATION FORM FOR STATUTORY MATERNITY LEAVE
Please complete and return this form to Human Resources, EC Stoner Building by the 15th week before the Expected Week of Childbirth (EWC). You may, if you wish, change your commencement date provided that at least 28 days notice is given of the new start date.
NAME: .......................................................................................................
JOB TITLE: ..
SCHOOL: ...
I wish to apply for statutory maternity leave on the terms set out in the Universitys guidelines.
a) I confirm that I have notified my Head of School/Service that I am pregnant and of the date I wish to commence my maternity leave.
b) I would like my 52 weeks maternity leave to commence on / / .
c) I confirm that I will send to you my medical certificate (Mat B1 form) which will confirm my expected week of childbirth. Please ensure that your MAT B1 shows your name in the same format that you use for university payroll purposes.
d) I understand that I may be eligible for Statutory Maternity Pay (SMP) for a period of 39 weeks from the commencement of my maternity leave if I have the required length of service and my average weekly earnings are above the lower earnings limit for National Insurance contributions.
Alternatively, if I am not entitled to SMP I may be entitled to Maternity Allowance (MA) which can be claimed through the Job Centre Plus or Social Security Office.
e) I understand that, subject to the agreement of my Head of School/Service, I may undertake 10 Keeping in Touch Days during maternity leave without it affecting my SMP. If I exceed 10 days, I will have deemed to have returned to work and my maternity payments will cease. I also understand that if I start work with another employer who was not employing me during the qualifying week (i.e. 15 weeks before the EWC) my SMP payments may be shortened.
f) I understand that should I wish to return to work before the end of my maternity leave, I am required to notify my Head of School/Service in writing no later than 8 weeks before my intended return date. However, this notice period may be varied, by agreement with your Head of School/service/Section.
g) Pension Arrangements
For USS/PAS members
I understand that if I am eligible for Statutory Maternity Pay (SMP) I will continue to make pension contributions during my paid leave. If I am not eligible for SMP but eligible for Maternity Allowance (MA), I understand that the University will continue to make pension contributions on my behalf. These contributions will be at the normal rate of my notional salary and I will be credited with full pensionable service during my 39 weeks paid maternity leave. During my unpaid maternity leave I understand I may choose to maintain my pension contributions and these will be at the normal rate of my full annual salary. Arrangements can be made for me to repay the contributions on my return to work. If I wish to do so, I understand that I must contact the Pensions Office to make the necessary arrangements within 3 months of my return to work.
For NHSPS members
I understand that if I am eligible for Statutory Maternity Pay (SMP) I will continue to make pension contributions to the National Health Service Pension Scheme (NHSPS) during my paid leave. If I am not eligible for SMP but eligible for Maternity Allowance (MA), I understand that the University will continue to make contributions to the NHSPS on my behalf. These contributions will be at the rate of 6% of my notional salary and I will be credited with full pensionable service during my 39 weeks paid maternity leave. During my unpaid maternity leave I understand that I am required to continue to make pension contributions and these will be at the rate of 6% of my full annual salary. Arrangements can be made for me to repay the contributions on my return. I understand that in this connection, I must contact the Pensions Office to make the necessary arrangements within 3 months of my return to work.
Should you wish to discuss your pension options further, please contact the Pensions Office on ext 34147.
h) I confirm that the following address should be used to send pay advices etc after my leave has begun:-
. . . .
Please provide a contact phone number and/or email address should we need to contact you once you commence your maternity leave.
Phone Email .
Signed: ......................................................... Date: ...................................
HUMAN RESOURCES
Corporate Services
PAGE 2
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