Sample declaration

Time off when your partner is pregnant


  1. I am the father of the expected child or the pregnant woman’s husband/civil partner or the pregnant woman’s live-in partner or an intended surrogate parent of the expected child.
  2. I am taking time off work in order that I may accompany the pregnant woman when she attends an appointment for the purpose of receiving ante-natal care.
  3. The appointment in question has been made on the advice of a registered medical practitioner, registered midwife or registered nurse.
  4. The date of the appointment is________________________. The time of the appointment is ________________.



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