Here is a sample of a maternity leave extension letter: Samantha Rhodes, Manager, ABL Corporation Ltd., 6 Highway Street, Dear Mrs. For that she needs to submit Form C (doctor's certificate of pregnancy) & Form F (receipt of Maternity benefit) She can be treated as LWP post 1 month after the end of 6 weeks after the date of child birth. Leave application can be written for many reasons out of which, one is Maternity leave . She can ask for an extension of Maternity leave upto 1 month in case of complications post delivery. But that would be counter productive. The certificate will serve as a proof that the patient duly attended the dental appointment. I wish to request for a maternity leave of 90 days to enable me to prepare for delivery and have some time to bond with my baby when it comes. Also under §825.112, leave to give birth and care for a newborn is a separate ground for FMLA leave apart from serious health conditions. ⢠Medical leave due to your own serious health condition. The FMLA medical certification form asks whether the qualifying condition is pregnancy, but this appears to ⦠Maternity Leave Application is a form of aformal letterthat is written by an employee asking for leave. Sub; Maternity leave request. It should state that you are having post natal problems still and it will take some more time to recover. A maternity leave application may be written to send to the boss in your ⦠The DOL's medical certification form for employees or a custom-tailored form can help answer whether an employee's request for medical leave is a serious health condition covered by the FMLA. Here is a sample of application for medical leave. Dear Mr./Ms. We cannot approve your application for these types of medical leave or family leave without certification from a healthcare provider. Our leave extension letter in an email format will guide you through writing a formal and concise letter. Either way, the extension letter aids the new mom to request an extended leave from the office. Dental Medical Certificate Templates â If the reason for the employeeâs leave application was to undergo a dental examination or consultation, then the designated dentist must draft a dental medical certificate. ⢠Medical leave due to your own pregnancy/childâs birth. Subject: Maternity Leave Extension Needed. Maternity Leave Extension Letter #2 To: Joshua Carter Managing Partner Big Law Firm 123 Justice Ave. From: Stephanie Xavier Lawyer Date: December 10, 2009 Subject: Extended Maternity Leave Mr. Carter, I am writing to you today to ask for an extension in my current maternity leave. ⢠Family leave to take care of a family member with a serious health condition. But here in India, maternity leave is for a fixed period only and after that your earned leave ⦠Sick or Medical Leave Application Sample for Employee: Just because the person is working for the organization it doesnât mean that the employee is applicable to take leave. (Name of recipient), This is with regard to an extension I require for my maternity leave. My scheduled leave is from October 10 to December 20. It is granted for someone who works 156 days before applying for the leave. Application for Leave Extension for Emergency Medical Treatment (Maternity Leave) [Here briefly focus on sample application format for leave extension from office, job, school or any other working place due to Emergency Medical Treatment, like, Maternity Leave⦠Maternity leaves are given by most countryâs to workingwomen, but extension request are added days off by the new mother. 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