Sick (fit) note request

First date you were not at work due to this illness:

Please use this date format: DD/MM/YYYY.

Is this an extension for a sick note or a new one?

Extension

New

Start date needed for Sick / Fit Note:

Please use this date format: DD/MM/YYYY.

End date needed for Sick / Fit Note:

Please use this date format: DD/MM/YYYY.

If the end date is unknown, please state “Ongoing” or give a number of weeks.

Describe your illness and why you need a Sick / Fit Note:

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