Requesting an additional Sick (Fit)

Last Updated: 19/10/2023

Your Details

Full Name

Date of Birth
For example, 15 3 1984

Day

Month

Year

Phone Number (optional)

Email Address
Sick/Fit Note

FIRST DATE YOU WERE NOT AT WORK DUE TO THIS ILLNESS
For example, 15 3 1984

Day

Month

Year

What date does your previous sick note end
For example, 15 3 1984

Day

Month

Year

TOTAL NUMBER OF DAYS YOU WERE ILL OR IS STILL ONGOING

DESCRIBE YOUR ILLNESS AND WHY YOU NEED A SICK / FIT NOTE

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