Maternity, adoption or shared parental leave: Free subs application form

Applications should be sent to Accord before the period of maternity/adoption leave starts. Please read the rules and check you’re eligible before completing this form. If an application is received after the period of leave starts, no retrospective refunds will be due, but will apply to the remainder of the period of leave.

A. Details

First name*

This field is required

Surname*

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Employee Number / ID*

This field is required

Email address (whilst on leave)*

This field is required

Please enter a valid email address

This type of email address is internal to LBG and cannot be used externally. Please provide an external email address.

Personal phone number (whilst on leave)*

Please enter a valid phone number

B. Workplace

Employer

This field is required

Workplace address*

This field is required

Start typing your address Enter address manually

Contact address Change address

Address line 1*

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Address line 2

Town*

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County

Postcode*

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Date leave starts*

DD MM YYYY

Please enter a valid date

Would you like your lottery tickets to continue on leave?*

Yes

This field is required

Please upload ONE of the following documents*:
• Copy of MAT B1 form (for maternity leave)
• Copy of the matching certificate (for adoption leave)
• Confirmation from your line manager
• Some other formal documentation to support the period of leave

Uploads are limited to six files at 16Mb each.

Upload your document here

Please upload a document

Please make sure you contact Accord before returning to work to ensure you’re paying the correct subscriptions

C. Confirmation

I confirm I have read and understand the rules and I’m eligible to claim for a free period. I understand that I will not receive any retrospective refunds if I claim after my period of leave starts.

This field is required

Need help? Call: 01189 341 808 (9am-5pm)