Form GPCD1

DECLARATION BY EMPLOYEE

GOVERNMENT-PAID CHILDCARE LEAVE (GPCL) SCHEME AND

EXTENDED CHILDCARE LEAVE (ECL) SCHEME
This form will take about 3 minutes to complete.

Before you start,

i) Please read the scheme information at https://www.profamilyleave.msf.gov.sg/schemes/childcare-leave/

ii) Please note that apart from Part 6, all references to “you” or “I” in this form shall be taken to be a reference to you, the
applicant, who is applying for Childcare/ Extended Childcare Leave.

iii) Please remember to submit a copy of the following documents to your employer for verification, along with this form:
• Your child’s birth certificate (not required for foster parent/kin carer)
• Singapore citizenship certificate of child (if applicable) (not required for foster parent/kin carer)
• Letter of Identity for foster parent/kin carer (if applicable)
• Legal Guardianship document (if applicable)

All fields and tick boxes are mandatory unless otherwise stated.

Scheme applied for (please tick one)

 Childcare Leave (GPCL)1  Extended Childcare Leave (ECL)1

Part 1: Parent Details

Name: NRIC / FIN:

Duration of employment in the relevant period2:

Note:
If you are submitting this form to your employer for the first time for the current relevant period (referred to in
Part 3), you will need to complete all the sections in the form. Otherwise, please skip Part 4.

Part 2: Declaration of Eligibility

Please indicate “Yes” to only one of the following options (a) and (b) below.

a. As at the date of this application, I have at least one child below the age of 7, who is a  Yes  No
Singapore citizen.

b. As at the date of this application, I do not have any child below the age of 7, who is a  Yes  No
Singapore Citizen, and have at least one child who is, or is above the age of 7 years but
below the age of 13 years who is a Singapore Citizen.”

1Please refer to the scheme information at https://www.profamilyleave.msf.gov.sg/schemes/childcare-leave/.

2“Relevant period” means any 12-month period as agreed to by the employer and employee. Where there is no mutual agreement
with the employer, the relevant period refers to a calendar year (1 Jan to 31 Dec).

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Part 3: Details of GPCL/ ECL

Note: The term “relevant period” means any 12-month period as agreed to by the employer and employee. Where
there is no mutual agreement with the employer, the relevant period refers to a calendar year (1 Jan to 31 Dec).

The relevant period applies for the entire duration of GPCL/ ECL until the employee becomes ineligible (i.e. does not
meet the eligibility criteria) or changes employer. If the employee changes employer and is still eligible for GPCL/
ECL, he/she may opt for a different relevant period subject to mutual agreement with the new employer.

❑ My employer and I have agreed that the following relevant period should apply
Start End

D D M M Y Y Y Y D D M M Y Y Y Y

❑ There is no agreement with my employer on the relevant period. I understand the “relevant period” will refer
to a calendar year.

Please indicate the date(s) which you will be taking the GPCL/ ECL.

Leave Date(s) Leave Duration

S/N
(DD/MM/YYYY) (Full-Day/Half-Day)

Part 4: Leave Consumption

❑ A. I have not applied for GPCL/ ECL with my previous employer(s) during the current calendar year.

❑ B. I have previously applied for GPCL/ ECL with my previous employer(s) during the current calendar year.

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If you have selected box B, i.e. taken GPCL/ ECL at any time during the current relevant period, please provide the
details below.

Days taken under the

Start date of employment Last day of employment
S/N previous employer (where
with the previous employer with the previous employer
applicable)

Number of days of GPCL/ ECL taken with previous employer(s) for the current calendar year: ___________

Part 5: Declaration by Employee

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

❑ (applicable only to a male employee who is the natural father of the child) I declare that:-
a) I am the natural father of the child in respect of whom the GPCL/ ECL is being applied; and

i) I am currently lawfully married to the natural mother of the said child; or

• I am not currently lawfully married to the natural mother of the said child; and

a. At the time the said child was conceived, both I and the child’s natural mother were not married to
any other person; or

b. I was lawfully married to the child’s natural mother at or after the said child was conceived.

❑ I declare that the child in respect of whom the GPCL/ ECL is being applied for has not been adopted by another
person, other than jointly with me.

❑ (applicable only to an employee who has more than 1 child) I agree to the allocation of leave in the manner
described in the FAQ.

❑ (applicable only to an employee who is a foster parent of the child) I am a foster parent to the child under a
voluntary care agreement entered into pursuant to the Children and Young Persons Act 1993, or pursuant to a
court order under the said Act, and I have not ceased to provide care, protection or supervision as a foster parent
to the child.

❑ I understand that:-
a) It is an offence under the Child Development Co-Savings Act 2001 to knowingly make any false or misleading
statement, provide, or cause or knowingly allow to be provided, any document or information which I know to
be false or misleading in a material particular, such offence being punishable with a fine not exceeding
$20,000 or to imprisonment for a term not exceeding 12 months or to both; and that upon conviction of such
offence, the court may, in addition to the prescribed punishment, order me to make restitution of any moneys
paid out to me by the Government in reliance of the false or misleading statement, document or information,
as the case may be; and

b) my employer or the Government may recover from me any moneys paid out to me in reliance of any false or
misleading statement, document or information, or by any error (however caused).

Name NRIC / FIN Signature & Date

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Part 6: Employer’s Acknowledgement

❑ I am satisfied that my employee is eligible for Childcare/ Extended Childcare Leave.

❑ I have agreed to allow my employee (referred to in Part 1) to take the Childcare/ Extended Childcare Leave on
the dates stated in Part 3; and

❑ I understand that if my employee has more than 1 child, the Childcare/ Extended Childcare Leave will be allocated
in the manner described in the FAQ.

Name & Designation NRIC / FIN Company Name Signature & Date

Note to employer:
This declaration form is to guide you in verifying the employee’s eligibility for Government-Paid Leave
Schemes (GPLS). You are not required to submit this form when submitting the claim for reimbursement.

Note to employee:
Please note that your employer can view the total number of days you have taken at “Consumed Childcare
Leave” in the Government-Paid Leave Portal. Should you have queries, please email us at
[email protected].

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