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Paternity Leave Request Form (UK)

Paternity Leave Request Form

STATUTORY PATERNITY LEAVE AND PAY REQUEST

Pursuant to the Paternity and Adoption Leave Regulations 2002 and sections 80A–80E of the Employment Rights Act 1996

Date: [Declaration Date]

To: [Manager Name]

[Employer Name]

PART 1 — EMPLOYEE DETAILS

Full name: [Employee Name]

Employee number: [Employee Number]

Department: [Department]

Employer: [Employer Name]

PART 2 — CHILD DETAILS

My relationship to the child: I am the [Relationship To Child].

Expected due date or expected matching date (for adoption): [Expected Due Date]

PART 3 — PATERNITY LEAVE REQUEST

I hereby give notice of my intention to take Statutory Paternity Leave as follows:

  • Duration of leave: [Leave Type]
  • Preferred start date: [Preferred Start Date]

I understand that Statutory Paternity Leave must be taken as a single block within 56 days of the actual date of birth or placement (or, if the child is born earlier than the expected week of childbirth, within 56 days of the first day of that expected week), in accordance with regulation 7 of the Paternity and Adoption Leave Regulations 2002.

I understand that, if the child has not yet been born at the time of submitting this notice, I may change the start date of my paternity leave by giving at least 28 days' written notice of the new start date (or such shorter notice as my employer may agree), as provided by regulation 6 of the Paternity and Adoption Leave Regulations 2002.

PART 4 — STATUTORY PATERNITY PAY

Claim for Statutory Paternity Pay: [Claim SPP]

Where I have confirmed that I wish to claim Statutory Paternity Pay (SPP), I confirm that SPP is claimed pursuant to sections 171ZA to 171ZEE of the Social Security Contributions and Benefits Act 1992. I understand that SPP is payable at the lower of the statutory weekly rate or 90% of my average weekly earnings, for the number of weeks of paternity leave I take.

PART 5 — STATUTORY DECLARATIONS

I make the following declarations in accordance with the Paternity and Adoption Leave Regulations 2002:

5.1 — Relationship

I declare that I am the [Relationship To Child] and that I satisfy the conditions of entitlement to Statutory Paternity Leave under regulation 4 of the Paternity and Adoption Leave Regulations 2002.

5.2 — Responsibility for the Child

Declaration that I will care for the child: [Caring Declaration]

I declare that I have, or expect to have, responsibility for the upbringing of the child, and that the purpose of my paternity leave is to care for the child or to support the child's mother or primary adopter.

5.3 — Continuous Employment

Continuous service confirmed: [Continuous Service]

I declare that I have been continuously employed by [Employer Name] for at least 26 weeks ending with the 15th week before the expected week of childbirth or the expected placement date, as required by regulation 4(2)(b) of the Paternity and Adoption Leave Regulations 2002.

PART 6 — ELIGIBILITY CONFIRMATION

I confirm that I meet all of the following eligibility conditions for Statutory Paternity Leave and (where claimed) Statutory Paternity Pay under the Paternity and Adoption Leave Regulations 2002 and sections 80A to 80E of the Employment Rights Act 1996:

1

I am the father of the child, or I am married to, the civil partner of, or the partner of the child's mother or primary adopter, as the case may be.

2

I have been continuously employed by [Employer Name] for at least 26 weeks ending with the 15th week before the expected week of childbirth or the expected placement date.

3

I have, or expect to have, responsibility for the upbringing of the child.

4

The purpose of my paternity leave is to care for the child or to support the child's mother or primary adopter.

5

I will be employed by [Employer Name] on the date my paternity leave begins (where claimed, for SPP: my average weekly earnings are not less than the lower earnings limit for National Insurance contributions purposes).

6

All information given in this form is true and accurate to the best of my knowledge and belief. I understand that providing false information may constitute a criminal offence and may result in disciplinary action.

7

I consent to my employer sharing relevant information with HMRC for the purposes of verifying my entitlement to Statutory Paternity Pay.

PART 7 — EMPLOYER ACKNOWLEDGMENT

For completion by the employer or HR department upon receipt of this form.

This request was received by [Employer Name] on: _______________________________

Received by (name and title): _______________________________

Confirmation of Statutory Paternity Leave: The employer confirms that the above employee's Statutory Paternity Leave has been noted and will commence as requested, subject to verification of eligibility. The employer will notify the employee within 28 days of the date of this request of the expected end date of the paternity leave, as required by regulation 11 of the Paternity and Adoption Leave Regulations 2002.

Employer's signature: _______________________________

Date: _______________________________

Employee

________________

Signature

Date: ________________

Employer / HR Representative

________________

Signature

Date: ________________

Maintained by Vladislav Sergienko, Founder·Template last modified: ·Report an error

What Is a Paternity Leave Request Form (UK)?

A Paternity Leave Request Form in the United Kingdom records an employment request, entitlement, or HR particular and the information the parties need to action it, and is governed by the Employment Rights Act 1996.

Statutory Paternity Leave allows an eligible employee to take either one week or two consecutive weeks of paid leave following the birth or adoption of a child. The purpose of the leave is to allow the employee to care for the child or to support the child's mother or primary adopter in the immediate period after the birth or placement. The leave must be taken within 56 days of the actual date of birth or placement and must be taken as a single block — it cannot be split into individual days or taken at different times. The leave period must end before the child's 56th day of life (or the 56th day after the first day of the expected week of childbirth, if earlier).

The right to Statutory Paternity Leave is available to the father of the child, the husband or civil partner of the child's mother, and the partner of the child's mother (including same-sex partners). It is also available in the context of adoption, where the primary adopter's partner may take paternity leave in respect of the placement. A person who is the parent of a child under section 42 or 43 of the Human Fertilisation and Embryology Act 2008 (for example, a female partner in a same-sex relationship where donor conception was used) is also entitled to statutory paternity leave. The right applies only to employees — not to workers or the self-employed — and requires a minimum of 26 weeks of continuous employment ending with the 15th week before the expected week of childbirth.

Statutory Paternity Pay is payable during paternity leave at the lower of the statutory weekly rate (set by HMRC and reviewed annually in April) or 90% of the employee's average weekly earnings for the eight weeks ending with the qualifying week. SPP is administered by the employer, who recovers the cost from HMRC through the PAYE system. Many employers offer enhanced contractual paternity pay, which supplements or replaces SPP. Where an employer's contractual pay equals or exceeds the statutory rate, the employer satisfies its SPP obligation through the enhanced payment.

Statutory Paternity Leave is distinct from, and additional to, any entitlement the employee may have to Shared Parental Leave under the Shared Parental Leave Regulations 2014. An employee may take both statutory paternity leave and shared parental leave in respect of the same child. Taking paternity leave does not reduce the total Shared Parental Leave entitlement available between the two parents. This means a father or partner can take up to two weeks of paternity leave immediately after the birth and then, separately, take one or more blocks of Shared Parental Leave later in the child's first year.

A formal written request for paternity leave creates a clear contemporaneous record, confirms the employer cannot dispute the entitlement, and protects the employee's right to enforce their leave through the Employment Tribunal under section 80H of the Employment Rights Act 1996 if the employer refuses or fails to deal with the request properly. Employees who are refused paternity leave or subjected to detriment for taking it can bring claims in the Employment Tribunal for automatic unfair dismissal under section 99 of the Employment Rights Act 1996 and for detriment under section 47C.

When Do You Need a Paternity Leave Request Form (UK)?

A Statutory Paternity Leave and Pay Request Form is needed whenever an eligible employee in England and Wales intends to take one or two weeks of paid leave following the birth or adoption of a child. The notice is a legal prerequisite for statutory paternity leave — an employee cannot simply take the leave without first giving their employer the required written notice under regulation 6 of the Paternity and Adoption Leave Regulations 2002. The notice must be given in writing and must contain the information prescribed by the Regulations.

The most common situation in which a paternity leave request is required is following the birth of the employee's child or their partner's child. In this case, the employee must give their employer notice no later than the 15th week before the expected week of childbirth — which corresponds broadly to the start of the third trimester of pregnancy. This notice period is designed to give employers sufficient time to plan for the employee's absence and to arrange cover where necessary. If the employee fails to give notice by the 15th week before the EWC, they may be disentitled to statutory paternity leave, unless there is a good reason for the late notification.

A paternity leave request is also required when the employee and their partner are adopting a child. In the adoption context, the employee must give notice within seven days of being notified of the match by the adoption agency. Given that the timing of adoption matches can be less predictable than a pregnancy due date, the Regulations allow for this shorter but still mandatory notice period. The notice must include the expected placement date, which will usually be communicated to the employee by the adoption agency as part of the matching notification.

Where an employee gives notice of their intended start date before the child is born or placed, a further written notification is needed to confirm or vary the start date once the birth or placement has occurred. This variation notice must be given at least 28 days before the new start date, or such shorter notice as the employer agrees. The employer must then, within 28 days of receiving the paternity leave notice, write to the employee confirming the expected end date of the paternity leave.

A paternity leave request is also needed by same-sex partners, civil partners, and non-married partners who are not the biological father of the child but who satisfy the relationship test under regulation 4 of the Paternity and Adoption Leave Regulations 2002. These employees have the same entitlement to statutory paternity leave and pay as a biological father, provided they meet the continuous employment and eligibility criteria. The right is gender-neutral — any person who is the partner or co-parent of the child's mother or primary adopter qualifies, regardless of the sex of the parties.

Paternity leave may also be needed where a father or partner plans to take paternity leave in addition to a period of Shared Parental Leave later in the year. In this case, the paternity leave notice should be given in the usual way, and the SPL notice can be given separately at the appropriate time. The two types of leave operate independently and can be used together to maximise the total amount of paid leave available to the family in the child's first year.

Even where an employer has an enhanced contractual paternity policy and will pay more than the statutory rate, the statutory notice requirements of the Paternity and Adoption Leave Regulations 2002 still apply and must be satisfied. The employer's enhanced policy does not replace or waive the obligation to give proper statutory notice, and failure to comply with the notice requirements may disentitle the employee from statutory paternity pay even if they retain an entitlement to contractual enhanced pay.

What to Include in Your Paternity Leave Request Form (UK)

A Statutory Paternity Leave and Pay Request Form for use in England and Wales must contain several key elements to comply with the Paternity and Adoption Leave Regulations 2002. Failure to include the required information may result in the employer declining to process the leave, potentially exposing the employee to loss of statutory paternity pay and leave entitlement, and requiring a fresh notice to be submitted.

First, the form must identify the employee clearly, including their full name, employee number, department, and employer. These details allow the employer to verify the employee's employment history, calculate the qualifying week, and determine eligibility for both statutory paternity leave and Statutory Paternity Pay. The employee's department and manager details help confirm the form reaches the correct HR contact and enables prompt arrangement of cover during the leave period.

Second, the form must state the employee's relationship to the child — whether they are the father, spouse, civil partner, or partner of the child's mother or primary adopter. This confirms that the employee satisfies the relationship test under regulation 4 of the Paternity and Adoption Leave Regulations 2002. The relationship determines the applicable statutory basis for the leave, and the declaration must be accurate, as providing a false relationship declaration may constitute a criminal offence.

Third, the form must state the expected week of childbirth or the expected placement date for adoption. For a birth, this determines the 15th-week notification deadline and the 56-day leave window within which the paternity leave must start and end. For an adoption, the expected placement date determines the seven-day notification deadline. The expected due date also determines the qualifying week (the 15th week before the EWC) and the 26-week continuous employment test runs back from that week.

Fourth, the form must specify the duration of leave the employee intends to take — either one week or two consecutive weeks. Statutory paternity leave cannot be taken in individual days, and the employee cannot choose a period shorter than one week or longer than two weeks. The employer needs to know the duration in advance to plan operational cover. Under the Regulations, the employee may not change the duration of their leave once notice has been given without the employer's agreement.

Fifth, the form must state the preferred start date for the paternity leave. This should be within the 56-day window following the actual or expected birth or placement date. If the employee does not yet know the exact start date because the child has not yet been born, they may give a provisional start date and then notify the employer of the actual start date as soon as reasonably practicable after the birth, giving at least 28 days' notice of the revised date.

Sixth, the form should include the employee's claim for Statutory Paternity Pay, confirming that they meet the 26-week continuous service and lower earnings limit requirements under the Social Security Contributions and Benefits Act 1992. Where an employee's average weekly earnings in the eight weeks before the qualifying week are below the lower earnings limit for National Insurance (£123 per week in 2024-25), they will not be entitled to SPP, although they may still qualify for Statutory Paternity Leave.

Seventh, the form must include three statutory declarations: a declaration that the employee has responsibility for the child's upbringing; a declaration that the main purpose of the leave is to care for the child or support the child's mother or primary adopter; and a declaration confirming 26 weeks of continuous employment. All three declarations are conditions of entitlement under regulation 4 of the Paternity and Adoption Leave Regulations 2002 and must be made honestly. The employer's acknowledgment section, completed on receipt, confirms the agreed leave dates and triggers the employer's obligation to notify the employee in writing of the expected return date within 28 days, as required by regulation 11 of the Paternity and Adoption Leave Regulations 2002.

Under the Employment Rights Act 1996, the Employment Tribunal adjudicates workplace disputes. Section 94 of the Employment Rights Act 1996 provides the right not to be unfairly dismissed. The Advisory, Conciliation and Arbitration Service (ACAS) provides early conciliation under Section 18A of the Employment Tribunals Act 1996. The UK GDPR and Data Protection Act 2018 govern personal data handling. HM Revenue and Customs (HMRC) administers PAYE and National Insurance contributions under the Income Tax (Earnings and Pensions) Act 2003. The forms-legal.com Paternity Leave Request Form (UK) template covers the mandatory elements under Employment Rights Act 1996.

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Forms Legal. (2026). Paternity Leave Request Form (UK) (United Kingdom) [Legal document template]. Forms Legal. https://forms-legal.com/uk/employment/hr-forms/paternity-leave-request-uk

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BibTeX
@misc{formslegal-paternity-leave-request-uk,
  author       = {{Forms Legal}},
  title        = {Paternity Leave Request Form (UK) (United Kingdom)},
  year         = {2026},
  howpublished = {\url{https://forms-legal.com/uk/employment/hr-forms/paternity-leave-request-uk}},
  note         = {Free legal document template. Based on Employment Rights Act 1996}
}

Frequently Asked Questions

Based on Employment Rights Act 1996 — Template last modified June 2026Verify the source →

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