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Paternity Notification Form

This paternity notification form provides information about an employee requesting paternity leave from their employer. It includes the employee's name and position, their wife's name and home address, and the expected due date of the pregnancy. The employee must check whether this is their first, second, third, etc. child and provide supporting documents like a marriage certificate or doctor's note. By signing, the employee certifies the information is true and correct to secure eligibility for paternity leave benefits under the law.

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May
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529 views1 page

Paternity Notification Form

This paternity notification form provides information about an employee requesting paternity leave from their employer. It includes the employee's name and position, their wife's name and home address, and the expected due date of the pregnancy. The employee must check whether this is their first, second, third, etc. child and provide supporting documents like a marriage certificate or doctor's note. By signing, the employee certifies the information is true and correct to secure eligibility for paternity leave benefits under the law.

Uploaded by

May
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PATERNITY NOTIFICATION FORM

Employee Name: ___________________________________________________________

Position Title: ______________________________________________________________

Wife's Name: First Name ________________ Maiden Name ______________________

Home Address: ____________________________________________________________

____________________________________________________________

This is to notify my employer that my wife is pregnant and is expected to

give birth on (due date) ___________________________. This will be her

[ ] first [ ] second [ ] third [ ] fourth [ ] ___________ delivery

(counting all childbirths and miscarriages).

As supporting document(s). I have attached:

[ ] photocopy of marriage contract (only for the Initial Notification)

[ ] physician's certification as to expected date of delivery

I certify on my honor that the foregoing information is true and correct, and
that I am providing such information for the purpose of securing eligibility for
Paternity Leave Benefit as provided under R.A. No. 8187.

____________________________ ____________________

Signature of Employee Date

Endorsed by:

____________________________

Supervisor

Noted by:

____________________________

Unit Head

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