prImAry cArer is A Tesco colleAgue

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Form A: If the mum/primary carer is a Tesco colleague Section 1 Complete section 1 if you want to bring your maternity/adoption leave (and pay) period to an end early. MY MANAGER

I would like to bring my maternity/adoption leave (and pay) period to an end after weeks on

I understand that it’s not normally possible for me to cancel this notice once it has been given. tick

I have completed this form as I am entitled and intend to take Shared Parental Leave as detailed below I confirm that my partner has given their employer notice of their intention to take shared parental leave and that I agree with the amount of Shared Parental Leave that my partner is intending to take I do not intend to take Shared Parental Leave

SECTION 2 Complete section 2 if you are entitled to and wish to take Shared Parental Leave I am writing to let you know that I am eligible for, and that my partner and/or I intend to take, a period of Shared Parental Leave. The information below confirms my entitlement to take Shared Parental Leave my name

My maternity/ adoption leave started on: /

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my partners name

My maternity/ adoption leave ended/will end on: /

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My child’s due date (the date on my MatB1):

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My child’s date of birth/date of placement:

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Number of weeks maternity/adoption leave taken:

1

The total amount of Shared Parental Leave (in weeks) available to me and my partner is: 52 minus maternity/adoption taken

The total amount of Statutory Shared Parental Pay (in weeks) available to me and my partner is: 39 minus maternity/adoption pay received

I intend to take this many weeks’ Shared Parental Leave and Pay: My partner intends to take this many weeks’ Shared Parental Leave and Pay: I CONFIRM THAT: I satisfy the following eligibility criteria for Shared Parental Leave or I will have satisfied them by the time I take leave: tick

I had been employed for 26 weeks by the time I was 25 weeks’ pregnant / at the end of the week the adoption agency notified me of a matching date and I will remain working for Tesco until my first period of Shared Parental Leave I have the main responsibility for the care of my child with the child’s dad/my partner I have reduced my period of maternity/adoption leave or have returned to work before the end of my maternity/adoption leave My normal weekly earnings in the 8-week period ending with the 15th week before my child’s due/placement date were not less than the Lower Earnings Limit (currently £111 per week) I intend to care for the child during each week that I am receiving Shared Parental Pay I have provided any additional evidence requested

The information given in this form is accurate and I will inform you immediately if I cease to care for my child or if I cease to be eligible to take Shared Parental Leave or claim Statutory Shared Parental Pay. I enclose Form C from my partner providing the further information required from them. SECTION 3 Complete section 3 to notify Tesco of the specific periods of Shared Parental Leave you wish to take Leave notice

Additional details

The start and end dates of each period of Shared Parental Leave I intend to take:

The start and end dates of when I would like to receive Statutory Shared Parental Pay:

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END

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