Application for Maternity Leave Form (ML1)

COLLEAGUE DETAILS

Business

Colleague name

Employee number

Start date

MATERNITY DETAILS (To be completed by the colleague)

I give notice of my absence due to pregnancy or childbirth

MATB1 certificate
Yes Maternity Leave to start on .…../..……/….
enclosed

I participate in the Co-op

Childcare Vouchers Salary Yes No
Expected Week Sacrifice Scheme
of Childbirth .…../..…/….…
(EWC) I participate in the Co-op
Pension Salary Sacrifice Yes No
Scheme

NOTES

- Maternity Leave can’t start before the 11th week before expected week of childbirth.
- If you change your mind about when you want to begin your Maternity Leave after
you’ve completed this form, you must give your manager at least 28 days’ written notice
before the new date when you want your leave to start or the original start date
(whichever is the earliest), or as soon as you can if this isn’t practically possible.
- Maternity Leave will begin automatically if you’re absent because of illness for a
pregnancy-related reason in the four weeks before the expected week of childbirth.
- If your baby arrives early, and before you’ve begun your Maternity Leave, your
Maternity Leave period will start from the week of the birth. You should tell your
manager as soon as possible and confirm this in writing.

Colleague’s
Date
signature
Manager’s
Date
signature

Please give this form, together with your MATB1 certificate, to your manager who will
send them to HR Services.

Registered Office: Co-operative Group Limited, 1 Angel Square, Manchester M60 0AG. Reg No 525R. Registered in England and Wales.