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The form collects personal information, employment history for the past two years, and maternity details including expected week of childbirth, proposed start date, and return-to-work plans for the UHB or another NHS employer. It includes declarations regarding returning for at least three months or repayment obligations, manager endorsement, agreed annual leave and flexible working arrangements, and HR approval of maternity leave dates.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/maternity-leave-application-form-instructions-and-sections/277521/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/maternity-leave-application-form-instructions-and-sections/277521.png","ImageObject",442,249,{"name":88,"@type":89},"Ophelia","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-29","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":25},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What documents must be attached when submitting the maternity leave application?","Question",{"text":108,"@type":109},"Attach your original MAT B1 certificate to the form. Completing all details correctly and fully helps avoid delays in processing.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What maternity details are required in section C?",{"text":113,"@type":109},"You must provide the expected week of childbirth, the proposed start date for maternity leave, and whether you intend to return to work with the UHB or another NHS employer, including your planned return timing.",{"name":115,"@type":106,"acceptedAnswer":116},"What does the declaration cover and what happens if you do not return?",{"text":117,"@type":109},"The declaration includes signing agreement options about returning to work with Cardiff and Vale UHB or another NHS employer for a minimum of 3 months, and states that failure to return can make you liable to repay all maternity pay received, except any SMP element you are entitled to.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},277521,1789501718,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":25,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":4},7971461741311,"https://ap-avatar.wpscdn.com/avatar/74000253aff267980c6?x-image-process=image/resize,m_fixed,w_180,h_180&k=1779345379180704826","| \u003Cbr>MATERNITY LEAVE APPLICATION FORM\u003Cbr>When completed and countersigned by your manager this form should be returned to the HR Advisory Team. Please ensure that you attach your original MAT B1 Certificate to this form and that all details are completed correctly and in full to avoid delay in processing your maternity application. |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| \u003Cbr>A: PERSONAL DETAILS (to be completed by Employee) |  |  |  |  |  |  |  |  |\n| Name |  |  |  |  |  |  |  |  |\n| Home Address |  |  |  |  |  |  |  |  |\n| Telephone (home) |  | Telephone (work) |  |  |  | \u003Cbr>\u003Cbr>Hours of work per week |  |  |\n| Department |  | Employee No. |  |  |  | NI number |  |  |\n| Tick this box if you have more than one post within the UHB |  |  |  |  | Tick this box if you work for the UHB Nurse Bank |  |  |  |\n\n\n| \u003Cbr>B: Employment Details |  |  |  |\n| --- | --- | --- | --- |\n| \u003Cbr>Please list employment details for the past 2 years (present post first) |  |  |  |\n| EMPLOYER | POST | FROM | TO |\n|  |  |  |  |\n|  |  |  |  |\n\n\n| \u003Cbr>C: Maternity Details |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| \u003Cbr>Expected Week of Childbirth (Please attach your MAT B1 certificate) |  |  | / / |  |\n| \u003Cbr>When do you propose to commence your maternity leave? |  |  | / / |  |\n| \u003Cbr>Do you intend to return to work with this UHB or another NHS employer? |  |  | Yes / No / Undecided |  |\n| If YES when do you intend to return to work? (Please circle desired option) |  |  | After 26 weeks\u003Cbr>After 39 weeks\u003Cbr>After 52 weeks\u003Cbr>Other |  |\n| \u003Cbr>If other please specify date |  |  | / / |  |\n| Declaration (please sign one and delete the others):\u003Cbr>􀁸 I agree to return to work with Cardiff and Vale UHB or another NHS employer for a minimum of 3 months at the end of my maternity leave. Should I fail to return to work I will be liable to repay all of the\u003Cbr>maternity pay received, except for any SMP element to which I am entitled. SIGNED   DATE  \u003Cbr>􀁸 I agree that I will not be returning to work with Cardiff and Vale UHB at the end of my maternity leave SIGNED   DATE  \u003Cbr>􀁸 I am undecided as to whether or not I will not be returning to work with Cardiff and Vale UHB at the end of my maternity leave.\u003Cbr>SIGNED   DATE   |  |  |  |  |\n| This application is endorsed by:\u003Cbr>SIGNED (manager) |  |  | Date |  |\n| PRINT NAME (manager) |  |  |  |  |\n| Annual Leave arrangements agreed: |  |  |  |  |\n| Flexible Working arrangements agreed: |  |  |  |  |\n\n\n| \u003Cbr>FOR USE BY HUMAN RESOURCES DEPARTMENT |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- |\n| Maternity Leave Dates Approved: |  | From: |  | To: |  |  |\n| SIGNED (HRO) |  |  |  |  | Date |  |","cbCaic2A69jp37AV","https://ap.wps.com/l/cbCaic2A69jp37AV","pdf",18447,"English","# A: Personal details\n## B: Employment details\n# C: Maternity details\n## Declaration and endorsements\n# For use by Human Resources Department","[{\"question\":\"What documents must be attached when submitting the maternity leave application?\",\"answer\":\"Attach your original MAT B1 certificate to the form. Completing all details correctly and fully helps avoid delays in processing.\"},{\"question\":\"What maternity details are required in section C?\",\"answer\":\"You must provide the expected week of childbirth, the proposed start date for maternity leave, and whether you intend to return to work with the UHB or another NHS employer, including your planned return timing.\"},{\"question\":\"What does the declaration cover and what happens if you do not return?\",\"answer\":\"The declaration includes signing agreement options about returning to work with Cardiff and Vale UHB or another NHS employer for a minimum of 3 months, and states that failure to return can make you liable to repay all maternity pay received, except any SMP element you are entitled to.\"}]","MATERNITY LEAVE APPLICATION FORM - Instructions and sections | PDF"]