Form Gpcl1 - Government-Paid Childcare Leave (Gpcl) Scheme Declaration By Employee (Page 3 of 5) in pdf

Form GPCL1

Part F : Employee’s Declaration



I have read and understood the explanatory notes.



I hereby declare that all information given in this declaration is true, correct and complete.



I understand that –

a) if I knowingly make any false or misleading statement, or produce or furnish, or cause or knowingly allow to

be produced or furnished, any document which I know to be false or misleading in a material particular, I

shall be guilty of an offence under section 16 of the Child Development Co-Savings Act (Cap. 38A) (CDC

Act) and shall be liable on conviction to a fine not exceeding $20,000 or to imprisonment for a term not

exceeding 12 months or to both; and

b) my employer or the Government may recover from me any moneys paid out to me in reliance of a false or

misleading statement or document or by reason of a mistake of fact, pursuant to section 11 of the CDC Act.

________________________________

________________

_________________

_____________

Employee’s Name

NRIC No.

Signature

Date

Part G : Employer’s Acknowledgement



I understand that the 6 days of childcare leave is being granted to my employee with a Singapore citizen child

below the age of 7 years (regardless of the number of children below the age of 7 years) / I understand that the 2

days of extended child care leave is being granted to my employee whose youngest qualifying child is a

Singapore citizen and who is aged 7 years and above but below 13 years of age (regardless of the number of

children my employee has).



I have agreed to allow my employee (referred to in Part A) to take the childcare leave/extended childcare leave

on the dates stated in Part D.

____________________________

______________

_____________________

______________

Name & Designation

NRIC No.

Signature

Date

*Delete where applicable.

Note to employer:

Please do not submit this declaration form. However please keep this form for a period of 5 years from the

date the form is submitted to you by your employee, for verification of details if necessary.

Note to employee:

In completing this declaration, you have given consent to display the total number of days you have taken at

“View GPCL taken” in the Government-Paid Leave Portal. Should you have queries, please email us at

contactus@profamilyleave.gov.sg.

Updated July 2017

Page 3 of 5

Version 2017.1

Form Gpcl1 - Government-Paid Childcare Leave (Gpcl) Scheme Declaration By Employee Page 3

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