Form Gppl1 - Government-Paid Paternity Leave (Gppl) Scheme Declaration By Employee (Page 3 of 5) in pdf

Form GPPL1

(iii) I have agreed with my employer that I will take my paternity leave in one or more

 Yes

 No

periods based on my number of working days per week

within 12 months from the

child’s date of birth, on such days to be agreed between my employer and myself.



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

Format of taking leave

Note: Please ensure that your employee has met all the eligibility criteria and conditions (refer to

paragraphs 1 to 4 of the Explanatory Notes) before granting the paternity leave as the Government will not

reimburse you if your employee is not eligible for the Government-Paid Paternity Leave Scheme.

 Yes

 No

(i)

I have agreed to allow my employee to take his paternity leave continuously within 16

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

 Yes

 No

(ii) I have agreed to allow my employee to take his paternity leave in one or more periods

within 12 months from the child’s date of birth, on such days to be agreed between the

employee and myself.

________________________

_______________

_____________________

____________

Name & Designation

NRIC No.

Signature & Company Stamp

Date

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.

The total number of days in one or more such periods is the number of working days in a week multiplied by the number of

weeks of paternity leave in Part B(i), subject to a cap of 6 or 12 days.

Updated January 2017

Page 3 of 5

Version 2017.1

Form Gppl1 - Government-Paid Paternity Leave (Gppl) Scheme Declaration By Employee Page 3

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