Form M1

Notification of Maternity Leave and Pay Details

 
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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.
 
 
 
The IBC promotes environmental sustainability, and prefer to use e-mail to paper letters.
Would you like correspondence to be sent to you electronically?
Would you like correspondence to be sent to you electronically?
 
 
*Please indicate if you are a Newly Qualified Teacher
 
Please use 'add' button to provide more than 1 Personnel Number
 
 
 
Date of Commencement with HCC *
Date of Commencement with HCC
 
Date of continuous local government service *
Date of continuous local government service
 
Please state end date *
Please state end date
 
Date on which your baby is due *
Date on which your baby is due
 
Please indicate your Intention *
Please indicate your Intention
 
Date on which maternity leave or your resignation will commence *
Date on which maternity leave or your resignation will commence
 

NB. You cannot start your maternity leave earlier than the 11th week before the Expected Week of Confinement unless your baby is born early. In such circumstances the IBC will require a copy of your baby's birth certificate.

 
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)
 
A photocopy of my Mat B1 Certificate has been sent to the IBC
A photocopy of my Mat B1 Certificate has been sent to the IBC
 

You need to show your Mat B1 Certificate to your Line Manager and send a photocopy to the IBC. Your pay details cannot be completed until the IBC has received a photocopy of your Mat B1

 
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 box *
 
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 box *
 
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 box *
 
If I do not return form my maternity absence I acknowledge the right of the County Council to recover any outstanding sums due to the County Council 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 box *
 
Have you informed your Line Manager of your pregnancy?
Have you informed your Line Manager of your pregnancy?
 

You must inform the IBC as soon as you have done so, in order that we can inform them of their responsibilities to you and carry out a risk assessment.

 
 
When you submit this form, it will be sent to the e-mail address you supply in the next section and the IBC.
 
If you would like a copy of the form for your own records, please use the print button below, before you submit the form.
 
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