CHO3

Section 1

Name *

Grade *

Personnel Number *

Location *

PPS Number *

Expected date of birth

Paternity leave start date *

Paterntiy leave end date *

Section 2

Please indicate how you are the “relevant parent”

In the case of a child who is adopted the leave will apply to

Section 3:

Copy of the medical certificate signed by a registered medical practitioner confirming the pregnancy of the expectant mother and specifying the expected week of confinement

Copy of the birth certificate

Copy of certificate of placement (adoption)

Particulars in writing of the placement (intercountry adoption)

Copy of an applicable declaration of eligibility and suitability (intercountry adoption)

Agree

Paternity Leave Application Form - HR108(k1)