Form Gppl1 - Government-Paid Paternity Leave (Gppl) Scheme Declaration By Employee (Page 2 of 5) in pdf

Form GPPL1

(For the adoptive child)

The adoptive child is a citizen of Singapore. (If the answer is “Yes”, please ignore

(i)

 Yes

 No

question B (ii).)

(ii) The adoptive child is not a citizen of Singapore, but my wife and/or* I am/is/are* (*to

 Yes

 No

delete as appropriate) Singapore Citizen(s). I will apply for Singapore citizenship for

my adoptive child immediately upon obtaining the Adoption Order and will submit a

copy of the child’s Singapore citizenship certificate to my employer within 6 months

from the date of the Adoption Order.

Part E: Declaration of Marital Status

(Not applicable for adoptive fathers whose formal intent to adopt is on or after 1 Jan 2017)

(For the biological child)

 Yes

 No

(i)

I am/was lawfully married to the mother of the child (in respect of whose birth I am

applying for paternity leave) (“the child”) at the time the child was conceived or after

the child was conceived but before the child’s birth. (If the answer is “Yes”, please

proceed to Part F).

(ii) I will be lawfully married to the mother of the child within 12 months from the child’s

 Yes

 No

birth.

(For the adoptive child)

 Yes

 No

(i)

I was lawfully married at the time that I made an application to the Court to adopt the

child who is a citizen of Singapore / at the time the dependant’s pass* was issued in

respect of the child who is not a citizen of Singapore (If the answer is “Yes”, please

proceed to Part F)

(ii) I will be lawfully married within 12 months from the child’s birth.

 Yes

 No

Part F: Declaration by Employee

Service period

(i)

(For the biological child)

 Yes

 No

I have or would have worked for my employer from whom I am applying for paternity leave

for a period of at least 3 months immediately preceding the birth of my child.

(ii) (For the adoptive child)

 Yes

 No

I have or would have worked for my employer from whom I am applying for paternity leave

for a period of at least 3 months immediately preceding *the time I made an application to

the Court to adopt the child who is a citizen of Singapore / the time the dependant’s pass is

issued in respect of the child who is not a citizen of Singapore*

(*Delete as applicable).

Format of taking leave

Note: Please refer to paragraphs 1 to 4 of the Explanatory Notes on eligibility criteria, the point when you

can start to consume your paternity leave and the conditions to meet for your employer to seek

reimbursement from the Government in respect of your paternity leave.

(i)

I have agreed with my employer that my paternity leave will be:

 Yes

 No



1 week



2 weeks*

*Applicable to a father whose child’s date of birth (DOB) or to an adoptive father whose

formal intent to adopt (FIA) is on or after 1 Jan 2015. (If the DOB or FIA is between 1 Jan

2015 and 31 Dec 2016 (both dates inclusive), the 2

week of paternity leave is granted by

your employer on a voluntary basis.)

(ii) I have agreed with my employer that I will take my paternity leave continuously within

16 weeks of the child’s date of birth. (If the answer is “Yes”, please ignore question B

 Yes

 No

(iii).)

Updated January 2017

Page 2 of 5

Version 2017.1

Form Gppl1 - Government-Paid Paternity Leave (Gppl) Scheme Declaration By Employee Page 2

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