top of page

Emergency Leave or Holiday Request Form

First name*

Last name*

Birthday*

Dia

Mês

Ano

Email*

Phone*

Workplace name and address:*

Job title:*

Employer or contractor name:*

Type of leave requested:*

Paid holiday

Unpaid emergency leave

Start date of leave:*

End date of leave:*

Total number of days requested:*

Is the reason related to a personal, family, illness, or medical emergency?*

Personal

Family

Illness

Medical

Other

Have you already taken any leave this year?*

No

If yes, please specify the dates

How many days of annual holiday entitlement do you have remaining?*

Has your employer already approved or rejected any part of this request?*

Approved

Rejected

Pending

Do you have any supporting documents for your request (e.g., medical certificate, proof of emergency)?*

Yes

No

When do you expect to return to work?*

Is there anything else you would like to add regarding your request?*

Please ensure that any supporting documents or evidence are sent to CAIWU staff for review.

CAIWU

Mayday Rooms
88 Fleet Street
London EC4Y 1DH,

United Kingdom

Tel: 07517 799 510
Email: office@caiwu.org.uk

bottom of page