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[Insert name and job title of intended Recipient]

[Insert name of Employer Company]

[Insert address of recipient at employer]

[Insert date]

Dear [insert name]

Flexible working request

I am writing to request a flexible working arrangement under my statutory right, as set out in section 80F of the Employment Rights Act 1996. If agreed, this will amount to a change in my terms and conditions of employment.

I am eligible to make this request because:

1. •

   I am an employee of [insert name of employer company];

2. •

   [I am an agency worker making this request following my recent return from a period of parental leave. That leave began on [insert date] and I returned from it on [insert date];]

3. •

   [I