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Form for employee to request paternity leave and pay (adoption within UK before 6 April 2024)

Author: Jo Stubbs

When to use this model paternity leave form

Use this model form to give employees the means to request paternity leave and pay in respect of a child adopted from within the UK, where the expected date of placement is before 6 April 2024.

For a version of the forms reflecting reforms introduced by the Paternity Leave (Amendment) Regulations 2024, see our Form to provide notice of entitlement to paternity leave (adoption within UK on or after 6 April 2024) and Form to provide period of leave notice to take paternity leave (adoption within UK on or after 6 April 2024).