APPLICATION FOR CHILD CARE LEAVE

 

1.

Name of the Applicant :

 

2.

Designation :

 

3.

Dept/Office/Section :

 

4.

Name of Child for whom Child Care leave is applied for :

 

5.

Date of Birth of the Child :

 

6.

Date on which child will be attaining 18 years. :

 

7.

Is the child among the two eldest Children :

Yes/No

8.

EL in credit (as on date) :

 

9.

Period of Leave- Days :

Prefix/Suffix of holidays, if any :

From                         To

10.

Reason(s) for leave applied for :

 

11.

Total Child Care Leave availed till date :

 

12.

(a) Whether permission to leave station is required :

Yes/No

 

(b) If Yes, Address during leave period

 

13.

Date of return from last leave & nature and period of that leave

 

 

 

Date :                                                                                       Signature of applicant

Pay Card No.

Remarks of Controlling Officer

      Leave Recommended / Leave Not Recommended.

 

Date :                                                                                       Signature

Designation

Office