Paternity Leave Request Form (Adopted Child)

This form should be used in order to give employees the means to request paternity leave and pay in respect of a child adopted from within the UK.

In order to be eligible for paternity leave, the employee must be married to, or the civil partner or partner of, the child's adopter (or one of a couple jointly adopting a child). The employee must expect to have responsibility for the upbringing of the child and be taking the leave to care for the child or support the adopter. The employee must have at least 26 weeks' service, as at the end of the week in which the child's adopter is notified of the adoptive match.

Leave may only be taken during the period beginning with the date of the child's placement and ending 52 weeks after that date. Employees can choose to begin their leave:

• on the date on which the child is placed with the adopter
• from a specified chosen number of days after the date of the child’s placement
• from a specified predetermined date which is later than the first day of the expected week of the child’s expected date of placement.

Leave can start on any day of the week, and the employee can choose to take:

• one week of leave
• two consecutive weeks of leave
• two non-consecutive single weeks of leave.

In order to be entitled to statutory paternity pay, the employee must have average weekly earnings of at least the lower earnings limit for National Insurance purposes. Additionally, the employee must confirm that he or she has chosen to receive statutory paternity pay and not statutory adoption pay in respect of the child.

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