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Carer's Leave Request Letter

A completed fictional statutory carer's leave request letter identifying the dependant, pattern, notice and return-to-work arrangements.

Jurisdiction: England and Wales - completed fictional worked example

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Important: This sample provides general legal information only and is not legal advice. Check the law, prescribed forms and signing requirements that apply to your exact jurisdiction and circumstances before use.

# CARER'S LEAVE REQUEST LETTER

Date: 10 September 2029

Parties: Maya Singh and Westridge Renewables Ltd

## 1. Purpose of this letter

To: Grace Holt, HR Director, Westridge Renewables Ltd (Company No. 12750931), 31 Harbour Street, Newcastle upon Tyne NE1 2AB. I, Maya Singh, Project Coordinator, request carer’s leave under the Carer’s Leave Regulations 2024 to provide or arrange care for my father, Raj Singh, who has a long-term care need.

## 2. Relationship and facts

I request three working days on 23, 24 and 25 September 2029, followed by one day on 18 October 2029, a total of four days in this leave year. I confirm that I meet the statutory eligibility requirement and that the leave is for caring for or arranging care for a dependant; I understand the leave is unpaid unless enhanced by policy.

## 3. Request or confirmation

The request is made with the required notice and is not combined with annual leave, sickness absence or parental leave. My proposed handover is attached: Jordan Wells will monitor the battery-storage project inbox, and I will complete the supplier call on 20 September. I will not perform work while on leave except to respond to an agreed emergency contact.

## 4. Evidence and scope

Please confirm the dates in writing and record the leave separately from annual leave. I ask that any postponement comply with the statutory conditions, be explained in writing and offer alternative dates within the required period. I understand that taking or requesting carer’s leave must not cause detriment or dismissal and that my employment terms continue.

## 5. Legal reservations

I have not included unnecessary medical information. If Westridge needs a reasonable confirmation of the relationship or care need, please identify the lawful and proportionate requirement. I ask HR to discuss a temporary flexible pattern on my return if Raj’s care arrangements change, without treating this request itself as a flexible-working application.

## 6. Contact and timing

My contact during leave is maya.singh@westridge.example and I will return on 26 September for the first block and 19 October for the later day. Please tell my line manager only the dates and operational handover needed. I remain available to discuss an alternative arrangement and to correct any payroll or record error.

## 7. Signature and truthfulness

I confirm this request is truthful and made in good faith. Please acknowledge receipt by 13 September 2029. Maya Singh signs on 10 September 2029; Grace Holt signs the employer acknowledgement without waiving any statutory right or treating the request as a resignation.

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