Section F: Declaration of Other Parent/Partner Name: Address: National Insurance Number: name and address and contact Employer’s details. Please indicate if you are an office holder or self-employed and the nature of the employment. I confirm that I meet the following conditions: I have at least 26 employment (employed or self-employed) out of 66 weeks’ weeks prior to the relevant week (see definition in Section E). I have average weekly earnings of at least £30 during at least 13 of the 66 weeks prior to the relevant week. I confirm I am the father or mother of the child or partner, civil partner or spouse of the mother of the child. I agree to inform your employee immediately if I cease to meet the two conditions above. I consent to your employee taking SPL and ShPP as set out in Sections C and D above. I consent to providing details of my employer and for them to be contacted to confirm dates and eligibility. If you are the mother/main adopter: I confirm I am entitled to statutory maternity leave, statutory maternity pay or maternity allowance. I confirm that at the time of the birth or placement of the child I will share responsibility for the care of the child with your employee. I have curtailed my maternity leave and pay/adoption leave and pay/maternity allowance or will have done so by the time your employee commences SPL. I consent to you processing the information contained in this declaration. Signature:
Section F: Declaration of Other Parent/Partner Name: Address: National Insurance Number: Employer’s name and address and contact details. Please indicate if you are an office holder or self-employed and the nature of the employment. I confirm that I meet the following conditions: I have at least 26 weeks’ employment (employed or self-employed) out of 66 weeks prior to the relevant week (see definition in Section E). I have average weekly earnings of at least £30 during at least 13 of the 66 weeks prior to the relevant week. I confirm I am the father or mother of the child or partner, civil partner or spouse of the mother of the child. I agree to inform your employee immediately if I cease to meet the two conditions above. I consent to your employee taking SPL and ShPP as set out in Sections C and D above. I consent to providing details of my employer and for them to be contacted to confirm dates and eligibility. If you are the mother/main adopter: I confirm I am entitled to statutory maternity leave, statutory maternity pay or maternity allowance. I confirm that at the time of the birth or placement of the child I will share responsibility for the care of the child with your employee. I have curtailed my maternity leave and pay/adoption leave and pay/maternity allowance or will have done so by the time your employee commences SPL. I consent to you processing the information contained in this declaration. Signature:
Family_Pack_Final_Version.docx