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Maternity Leave Notification

A completed fictional employee notification of pregnancy and intended maternity leave dates, recording information without assuming eligibility or an employer decision.

Jurisdiction: England and Wales - completed fictional worked example

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An editable Microsoft Word version is available from the interactive page.

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 NOTIFICATION

Date: 1 July 2038

Parties: Employee: Hannah Lewis, Product Coordinator, Northbridge Analytics Ltd, 6 Market Street, Leeds LS1 5AB. Recipient: Sophie Bell, HR Manager. Expected week of childbirth: week beginning Sunday 17 October 2038.

## 1. Notification and certificate

On 1 July 2038 I notify Sophie Bell that I am pregnant and give the employer my MAT B1 certificate issued on 30 June 2038. The certificate states an expected week of childbirth beginning Sunday 17 October 2038. The employer should store this personal information securely and use it only for lawful employment purposes.

## 2. Intended leave dates

My intended first day of ordinary maternity leave is 3 October 2038. If I take the full available period, my provisional return date is 2 October 2039. I understand the dates are intentions, not a waiver of statutory rights, and that childbirth or a qualifying health and safety event may affect them.

## 3. Pay, eligibility and contact

Please assess statutory maternity pay, maternity allowance information and any contractual scheme using my actual service, earnings and the current rules; I do not assert eligibility in this letter. During leave, contact me at 18 Rose Street, Leeds LS7 2DT, or hannah.lewis@example.invalid, unless I provide updated details.

## 4. Risk assessment and handover

Please arrange a pregnancy-related workplace risk assessment with me and discuss any necessary adjustments confidentially. I will prepare a handover for the client dashboard by 15 September 2038, but health advice may affect that date. We can discuss keeping-in-touch days separately; they are not required by this notification.

## 5. Acknowledgement and execution

Please acknowledge by 8 July 2038, confirm the recorded dates, and explain the current policy, forms and appeal or query route. This notification does not predetermine leave eligibility, pay, consultation or any future employment outcome. Hannah Lewis signed 1 July 2038; Sophie Bell signed receipt on the same date. Current UK law, forms and deadlines must be verified.

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