Application for Maternity Leave

0%

1. Application for Maternity Leave
Page 1 of 5

Please ensure that you have submitted your Mat B1 form along with this application for it to be processed. (NOTE:- THIS APPLICATION DOES NOT CONFER ANY RIGHT TO PARTICULAR BENEFITS. YOUR ENTITLEMENTS WILL BE CHECKED AND SUBSEQUENTLY CONFIRMED TO YOU IN WRITING AS SOON AS POSSIBLE.)

1. Employee Details *

Full Name	*
Home Address	*
Branch	*
Post Held	*
Contracted Hours	*
Date of Birth	*
Email address	*

2. Type of Contract *

Full Time
Part Time
Variable
Bank

3. Employment start date with Pegasus Homecare Ltd *

	DD/MM/YYYY

4. My expected date of the birth of my child is *

	DD/MM/YYYY

5. My Mat B1 one for signed by a midwife or medical practitioner *

is enclosed
will be forwarded to you as soon as reasonably practicable