RESTRICTED STAFF (When completed)

REWARD

Maternity CR-025-13 v1.0

Page 1 of 2 Notification of Pregnancy Form Part 2 CR-025-13-F2 v1.0

(When completed) RESTRICTED STAFF

CR-025-13-F2 Version 1.0

NOTIFICATION OF PREGNANCY FORM PART TWO

PART ONE – To be completed by the employee

Employee Details

Full Name: Police No:

Area/Department: Rank/Grade:

HR CASE REFERENCE NUMBER:

I hereby confirm that my expected date of childbirth is:

The original signed MATB1 form is attached.

If the MATB1 is not yet available other evidence is acceptable e.g. a letter signed by a doctor or midwife that includes the pregnant woman’s name and the expected date of childbirth. It must be stamped and if issued by a midwife must include the midwife’s PIN number and the expiry date of registration. The MATB1 should be submitted as soon as possible thereafter.

I wish to start my maternity leave on:

My last working day will be:

Maternity Pay

I wish to receive FULL pay for: (Please tick one)

18 weeks FULL pay followed by 21 weeks Statutory Maternity Pay [SMP] [total of 39 weeks pay]

13 weeks FULL pay, followed by 10 weeks HALF pay, then SMP for 16 weeks [total of 39 weeks pay]

Other; please provide further detail below:

Maternity Leave

I wish to take: (Please tick one)

26 weeks leave only [OML]

39 weeks leave – maximum paid leave [includes OML]

52 weeks leave (paid and unpaid leave/OML and AML)

15 months leave (OML, AML and BTP Occupational Maternity Leave)

Other; please provide further detail below:

RESTRICTED STAFF (When completed)

REWARD

Maternity CR-025-13 v1.0

Page 2 of 2 Notification of Pregnancy Form Part 2 CR-025-13-F2 v1.0

(When completed) RESTRICTED STAFF

CR-025-13-F2 Version 1.0

I wish to return to work on:

PART TWO - Declaration of Repayment

I undertake to repay1, if asked to do so, any salary paid to me as BTP Occupational Maternity Pay if I do not return to work for BTP for one month prior to ending my employment, beginning a career break or taking parental leave.

Signature: Date:

NOTES:

1

Employees who take parental leave or career break following maternity leave, must complete one months service when they eventually return to work, in order to fulfill their obligation.

2

This may not apply to employees who are unable to return to work due to a pregnancy/childbirth related sickness or medical condition.

3

This does not apply for an employee who does not return to work due to overlapping periods of maternity leave, providing that they sign and complete a second Notification of Pregnancy form, and return to work for BTP and complete one month’s service.

4

Repayment may be waived if the employee provides medical evidence that they are unable to return to work because the child is disabled and requires continuous attention at home.

PLEASE FORWARD COMPLETED FORM TO YOUR MANAGER

1 In accordance with the Loans, Advances and Overpayments SOP HR7:2.

LINE MANAGER PLEASE FORWARD THIS FORM ONTO THE HRBC AND INFORM ROSTERING OF DATES LEAVE IS INTENDED

ADMINISTRATION – To be completed by the HR Business Centre

Received By: Date:

Filed in personal file Date:

Entered on ORIGIN Date:

Payroll Informed Date: