Sick Notes Sick/Fit Note Request Name First Last Date of Birth Day Month Year Contact NumberAddress Street Address Address Line 2 City Postcode Email Enter Email Confirm Email Is this a new request or an extension? New request An extention First date you were not at work due to this illness: Day Month Year Dates to be covered by this Sick/Fit Note Describe your illness and why you need a Sick / Fit Note:Total number of days you were ill or state ongoing:
