WARSAW UNIVERSITY OF TECHNOLOGY 
         PL.POLITECHNIKI 1
         00-661 WARSAW
Warsaw,........................................ (date)

......................................................................	
(Name and surname)

......................................................................	
	(Organisational unit)

Vice-Rector for General Affairs / Chancellor
Warsaw University of Technology

REQUEST FOR A PATERNITY LEAVE 

Under Article 1823 of the Labour Code, due to the birth of my child:  

……………………………………………………………………………….., on ……………………………..…………………., 
                      (Name and surname of a child)

I hereby request a paternity leave   
from …………………….…………, to ………………………….amounting to ……………………..………..weeks (max. 2 weeks.).

I declare that I have informed the Head of organisational unit about my intention to use paternity leave in the aforementioned period. 								

								…………………………………..…………………………
							Signature of the father-employee