Government-Paid Childcare Leave (Gpcl) Scheme Declaration By Employee printable pdf download

Form GPCL1

GOVERNMENT-PAID CHILDCARE LEAVE (GPCL) SCHEME

DECLARATION BY EMPLOYEE

Child Development Co-Savings Act (Cap. 38A)

Child Development Co-Savings (Childcare Leave and Extended Childcare Leave) Regulations 2013

Before filling up the form (which may take you 3 minutes to complete), please note:

(i)

Read the explanatory notes before completing this declaration.

(ii) Save for Part 7 below, all references to “you” or “I” in this form shall be taken to be a reference to you, the

employee who is applying for childcare leave/ extended child care leave.

Scheme applied for (please tick one)

 Childcare Leave

 Extended Childcare Leave

(for parents with youngest child who is below 7 years old)

(for parents with youngest child who is between 7 and 12

years old (inclusive))

Part 1 : Details of employee

Name

NRIC No./ FIN No.

Designation of employee

Date when employee joined company

Note:

If you are submitting this form to your employer for the first time for the current relevant period (referred to in Part 4), you will

need to complete all the sections in the form. Otherwise, please proceed to Part 4.

Part 2 : Details of youngest child of employee

Name

Birth certificate No.

Date of birth

Part 3 : Declaration of Singapore citizenship

 Yes

 No

My youngest child is a Singapore citizen and is below 7 years of age / is aged 7 years

old and above but below 13 years old *at any time in the current relevant period

(referred to in Part 4)

Please attach a copy of the child’s Singapore citizenship certificate if the child is not

born as a Singapore citizen.

please delete where applicable

Part 4 : Details of childcare leave

The relevant period

agreed by both employer and you to take childcare leave/ extended childcare leave is as

follows:

Start

End

Note: The relevant period agreed upon will be used for the entire duration of childcare leave/extended childcare leave until the

employee becomes ineligible (ie does not meet the eligibility criteria) or changes employer. If the employee changes employer

and is still eligible for childcare leave/ extended childcare leave, he/she may opt for a different relevant period with the new

employer.

The “relevant period” refers to any period of 12 months as is agreed to by the employee and his employer; or where there is no

such agreement, a calendar year.

Updated 1 Aug 2014

Page 1 of 5

Version 2014.1

Government-Paid Childcare Leave (Gpcl) Scheme Declaration By Employee

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