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Maternity Leave Notice

A completed employee notice confirming pregnancy, statutory maternity leave dates, pay evidence, KIT arrangements and return planning without overstating entitlement.

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.

# MATERNITY LEAVE NOTICE

Date: 12 February 2029

Parties: Amelia Hart and Northmoor Analytics Limited

## 1. Employee, employer and notice

To Northmoor Analytics Limited, 14 Albion Quay, Leeds LS1 5RD: I, Amelia Hart of 9 Willow Bank, Harrogate HG1 2QR, confirm that I am pregnant and intend to take maternity leave in connection with my expected week of childbirth ending 23 March 2029. This is formal notice under the Maternity and Parental Leave etc. Regulations 1999.

## 2. Leave or policy entitlement

My maternity leave is requested from 18 March 2029. I understand that compulsory maternity leave applies immediately after childbirth, and that ordinary maternity leave (OML) and additional maternity leave (AML) together can cover up to 52 weeks. My intended return date is 17 March 2030; I will give at least eight weeks' notice if I change it.

## 3. Pay, service and working arrangements

Based on my qualifying service and average weekly earnings, I ask payroll to confirm whether I qualify for Statutory Maternity Pay: six weeks at 90% of average weekly earnings followed by 33 weeks at the statutory rate or 90% if lower. Any enhanced Northmoor maternity scheme is subject to its written terms; this notice does not invent a repayment condition.

## 4. Health, safety and equality

I am willing to discuss up to ten Keeping in Touch (KIT) days, but each day must be agreed in advance and paid as agreed. I will be contactable at amelia.hart@example.co.uk for urgent welfare or payroll matters; there is no expectation that I work during leave.

## 5. Records, review and return

Before leave, I will complete the handover for the Calder forecasting project by 1 March and provide a safe contact plan. Northmoor should review my pregnancy risk assessment, including travel to client sites, workstation arrangements and any recommended adjustments under the Equality Act 2010.

## 6. Statutory rights and reservations

My statutory rights remain protected, including continuity of employment, accrual of annual leave and the right to return to my role or an appropriate equivalent role as the law provides. This notice is not a resignation, flexible-working application or agreement to waive any right.

## 7. England and Wales law and acknowledgement

Please acknowledge receipt, confirm the payroll position and record the intended return date. I sign this notice on 12 February 2029 and retain a copy. Amelia Hart, Senior Data Analyst; acknowledged for Northmoor by Priya Shah, People Director.

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