# EXAMPLE: MATERNITY LEAVE REQUEST
Date: 14 July 2027
From: Emily Carter
To: the other party named in this worked example
## 1. Purpose and status
This is a completed fictional an employee's planned statutory maternity leave. It records the issuer's decision or request and is not legal advice. The recipient should check the facts, contractual terms and any statutory procedure before relying on it.
## 2. Facts and evidence
Emily notifies Northmere of her pregnancy and expected week of childbirth beginning 6 November 2027, supported by the required medical evidence.
The issuer considered the documents, dates and explanations reasonably available and has kept a clear record. No conclusion is intended to prevent a right to respond, appeal or request a reasonable adjustment.
## 3. Decision or request
She intends to start statutory maternity leave on 30 October 2027 and expects to return on 29 January 2028, while acknowledging that the return date may change under statutory rules.
She asks the employer to confirm statutory maternity pay, risk-assessment arrangements, antenatal appointment time and the agreed contact method during leave.
## 4. Rights and next steps
The employer will protect her maternity rights, consult about health and safety and keep her informed of material workplace changes. This notice is not a waiver of any statutory entitlement.
Any response must be in writing to the named issuer within the period stated above. A worker may be accompanied where the applicable procedure permits, and statutory rights under the Employment Rights Act 1996, Equality Act 2010, family-leave rules and the ACAS Code are not excluded.
## 5. Confidentiality and records
The letter is confidential, stored securely and shared only with people who need it for the employment process, legal advice or a lawful reporting duty. Personal data is handled under UK GDPR. The issuer will correct a material factual error and keep a proportionate audit trail.
## 6. Closing
This letter does not vary a contract unless it expressly says so and is accepted in the legally required form. Nothing limits whistleblowing, discrimination, maternity or other protected rights.
Yours sincerely,
Harriet Cole, for the issuer
Signature: ______________________________