Acknowledgement of Maternity Pay


(This letter serves to record payments made for and on behalf of an employee while on maternity leave for benefit contributions such as Medical Aid and Retirement Fund)

I, ___________________________________________ hereby acknowledge that I am indebted to (COMPANY NAME) for an amount of R ________________________ (state amount in words) for contributions made on my behalf for Medical Aid and/or Retirement Fund for the period of __________________ (Date of commencement of Maternity Leave) to _________________________ (Date Maternity Leave ends). The total sum of contributions being R __________________________.

I confirm that I have agreed that (COMPANY NAME) undertakes to continue contributing towards the Company’s Medical Aid and/or Retirement Fund on my behalf in terms of the (COMPANY NAME)’s Maternity Leave Policy, during my Maternity Leave period.

I hereby agree to work for (COMPANY NAME) for a period of 6 months after my return from Maternity Leave in order to fulfill my obligation to this agreement.

Should I leave (COMPANY NAME)’s services for any reason whatsoever within a period of 6 months after returning to work, I agree to repay the Company a pro rata portion of the Maternity Pay according to the pro rata formula below:

Work back period:           % Repayment due

0 Months                             100%
1 Month                               85%
2 Months                             70%
3 Months                             50%
4 Months                             35%
5 Months                             20%
6 Months                             0%

___________________________________                   _______________________________________

Employee Signature                                                      Date


__________________________________                     _______________________________________

Line Manager Signature                                                Date


__________________________________                     _______________________________________

Human Resources Signature                                       Date

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