Section 1
Section Navigation Bar
Form M1A

Variation to Maternity Notification

 
Padlock
Data Protection Act 1998 - we will only process your personal data in order to respond to your Maternity Request, which will be treated confidentially. In general it will be used for administrative, monitoring and statistical purposes.
 
For further information on maternity leave please check the HR Web Pages.
 
Please note that any information given on this form will be shared with your Line Manager.
 
Please use 'add' button to provide more than 1 Personnel Number
 
 
What information would you like to vary from your original notification - tick one or more boxes.
What information would you like to vary from your original notification - tick one or more boxes.
 
Date this address becomes effective
Date this address becomes effective
 
Are you requesting e-mails for the first time or amending a previously given e-mail address?
Please tick
Please tick
 
*Please indicate if you are a Newly Qualified Teacher
 
Please enter details for New Place of Employment
 
Please note that part of this payment will be recovered from you in the event that you do not return to the same job held prior to maternity leave for a period of 3 months (for HCC & school support staff) or 13 weeks or full time equivlent for (teaching staff).
Please note that the payment will be made to you upon your return to work, but will be recovered from you in the event that you do not return to work for a period of 3 months (for employees on EHCC terms and conditions) or 13 weeks, or full time equivalent (for teaching staff)
 
Date on which resignation will commence
Date on which resignation will commence
Date on which Maternity Leave will commence
Date on which Maternity Leave will commence
Original date on which resignation was due to commence
Original date on which resignation was due to commence
Revised date on which resignation will commence
Revised date on which resignation will commence
Original date on which Maternity Leave was due to commence
Original date on which Maternity Leave was due to commence
Revised date on which Maternity Leave will commence
Revised date on which Maternity Leave will commence
 
Is the revised date due to an early birth?
Is the revised date due to an early birth?
Please provide the actual date of birth
Please provide the actual date of birth

If your baby is born early, please supply a copy of your baby's birth certificate to the IBC.

 
I confirm that I am pregnant and the above information is correct. I also consent to Hampshire County Council processing this information and any relevant personal data for administrative purposes in relation to my pregnancy and my request for maternity leave and pay.
Please tick *
 
I undertake that, as detailed in the County Council's Maternity Benefits Scheme, an element of Occupational Maternity Pay will be repayable to the County Council if I give notice to terminate my employment before returning from maternity leave. If I am retired on health grounds or made redundant there will be no recovery of the financial assistance given to me. In other exceptional circumstances, I understand that consideration may be given to waiving in part or in total the requirement to repay the relevant element of OMP.
Please tick *
 
I acknowledge the right of the County Council to recover the sums due from any monies owed to me, e.g. final salary payment. If any further repayment of any sum is required, my manager/headteacher will discuss repayment arrangements with me.
Please tick *
 
eForms by AchieveForms