Form PAT1B

Paternity Leave and Pay Notification Form

 
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Data Protection Act 1998 - we will only process your personal data in order to respond to your Paternity Request, which will be treated confidentially. In general it will be used for administrative, monitoring and statistical purposes.
 
For further information on paternity leave please check the HR Web Pages.
 
Please note that any information given on this form will be shared with your Line Manager.
 
 
 
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
 
 
Is the Paternity for *
Is the Paternity for
 
Expected week of childbirth: *
Expected week of childbirth:
Expected week of placement *
Expected week of placement
Date of continuous local government service *
Date of continuous local government service
Date I was notified of the expected date of placement: *
Date I was notified of the expected date of placement:
 
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
A photocopy of the HM Revenue and Customs Paternity Self Certification form (SC3) has been sent to the IBC.
A photocopy of the HM Revenue and Customs Paternity Self Certification form (SC3) has been sent to the IBC.
 

You need to either show your Mat B1 Certificate or give a HR Revenue and Customs Paternity Self Certification form (SC3) 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 / SC3.

 
A photocopy of my Matching Certificate has been sent to the IBC.
A photocopy of my Matching Certificate has been sent to the IBC.
A photocopy of the HM Revenue and Customs Paternity Self Certification form (SC3) has been sent to the IBC.
A photocopy of the HM Revenue and Customs Paternity Self Certification form (SC3) has been sent to the IBC.
 

You need to either show your Matching Certificate or give a HR Revenue and Customs Paternity Self Certification form (SC3) 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 Matching Certificate / SC3.

 
An employee will be entitled to take either a period of one week’s leave or two consecutive weeks’ paternity leave. An employee is not able to take two separate weeks’ leave. The leave will only be granted in one-week blocks and not as single days. Leave can start on any day of the week. It must be taken within 56 days (8 weeks) of the date of childbirth, or placement for adoption, of the child, as agreed with their Line Manager.
 
I confirm that I wish to take paternity leave of: *
I confirm that I wish to take paternity leave of:
Commencing on:
Commencing on:
 
I have discussed my request for paternity leave with my Line Manger or Headteacher and that it relates to the birth of my child.
Please tick box *
 
I have discussed my request for paternity leave with my Line Manger or Headteacher and that it relates to the adoption of a child.
Please tick box *
 
I noted that I have a right to change my paternity leave and pay start date provided that I give at least 28 days written notice of the change
Please tick box *
 
I declare that I have elected to receive statutory paternity pay and not statutory adoption pay, in respect of this adoption
Please tick box *
 
I confirm that the above information is correct and that I understand and accept the conditions of the paternity leave and pay scheme. I also consent to Hampshire County Council processing this information and any relevant personal data for administrative purposes in relation to my request for paternity leave and pay.
Please tick box *
 
 
When you submit this form, it will be sent to your Line Manager 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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