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Paternity Leave Request

A completed fictional employee request for statutory paternity leave following a partner's expected birth, without presuming eligibility or leave approval.

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.

# PATERNITY LEAVE REQUEST

Date: 20 May 2025

Parties: Employee: Michael Chen, Operations Supervisor, Calder Foods Ltd, 22 Wharf Road, Manchester M4 4AB. Recipient: Laura Green, HR Manager. Partner: Amelia Roberts. Expected week of childbirth: week beginning Sunday 7 September 2025.

## 1. Family event and notice

On 20 May 2025, well before the applicable entitlement-notice deadline, I notify Laura Green that my partner Amelia Roberts is expecting our child in the week beginning Sunday 7 September 2025. I expect to be the child's biological parent and will share responsibility for the upbringing; HR should assess the statutory conditions rather than treating this statement as a final eligibility decision.

## 2. Requested leave

I request two consecutive weeks from 12 September through 25 September 2025, intending to return on 26 September 2025, but only if the child has been born by 12 September. I will give the separate leave-date notice by 15 August 2025, at least 28 days before the requested start. I understand the actual birth date and current legislation may affect the permitted window or require a revised notice, and I will notify HR promptly of a material change.

## 3. Pay and evidence

Please assess statutory paternity pay and any enhanced contractual payment against my service, earnings and the current rules. I will complete the required declaration and provide the expected week evidence and partner details through the approved secure channel; I will not send unnecessary medical information.

## 4. Work planning and contact

Before leave I will hand over the Trafford warehouse rota, stock-count log and supplier escalation list to Nadia Khan by 2 September 2025. Laura may contact me at 77 Alder Grove, Manchester M20 3QF about administration, but operational work during leave should be agreed lawfully and separately.

## 5. Response and signatures

Please acknowledge by 27 May 2025, confirm that this timely entitlement notice and the later separate 28-day date notice are recorded, and give the current forms, pay calculation and query route. This request does not predetermine eligibility, consultation, leave approval or any tribunal outcome. Michael Chen signed on 20 May 2025; Laura Green signed receipt on 21 May 2025. Verify current UK law, forms and deadlines.

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