Request Maternity Leave

Dear …

RE: Maternity Leave Request

Please accept this as my formal request for Maternity Leave from my position for__(# weeks/months)__.

In accordance with my doctor’s report, my estimated delivery date is __(date)__ and, therefore, I am requesting Maternity Leave to commence on approximately __(date)__. I anticipate returning to my position approximately __(date)__. OPTIONAL

Please find attached a letter of confirmation from my doctor.

Trusting this is the information you require to process my Maternity Leave request at this time. If additional information is required please advise me. Thank you.

Yours truly,

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