APPLICATION FOR CHILD CARE LEAVE (Auto Filled CCL File)

APPLICATION FOR CHILD CARE LEAVE (CCL)

1. Application Details

1. Name of the Applicant 2. Father/Husband Name

3. Designation 4. Date of joining in Govt. Service 5. Is the probation period clear Select... Yes No

6. Place of posting

Child Details (for current leave application)

7. Name of child for whom CCL is applied 8. Date of birth of the child

9. Date on which the child will attain 18 years of age 10. Is the child among the two eldest Select... Yes No

Leave Period & Reason

11. Period of leave (From) 11. Period of leave (To)

12. Prefix/suffix of holidays, if any 14. Total child care leave availed till date (in days)

13. Reason(s) for leave applied for To attend to son's minor surgery and post-operative care.

15. (a) Permission to leave station required? Select... Yes No 15. (b) If yes, address during leave period

15. (c) Contact No. 16. Date of return from last leave & nature and period of that leave

2. Undertaking & Family Details (Applicant)

I, ... W/o Sh. / D/o Sh. ... working as ... do hereby undertake and certify as under:

1. That I have following child/children:

Sr. No.	Name of Child	D.O.B.	Age (as of today)

2. That if at any stage either of the contents given above found incorrect/false, I shall be fully responsible for potential action.

Dated: ___________
Signature of Applicant

3. Checklist (Documents to be Enclosed)

• Application form for child care leave duly signed by the applicant with recommendation of Office in-charge.
• Proof of reason for applying child care leave.
• Undertaking regarding CCL application form.
• Self-attested photocopy of I.D. Card.
• Self-attested photocopy of Birth Certificate of the child.

4. Controlling Officer's Remarks/Recommendation (Editable)

*This section is typically completed by the sanctioning authority. Fill these details for testing the export functionality.

Recommendation/Remarks/Decision (e.g., Sanctioned/Rejected) Recommended for sanction, as the application is in order and within the entitled limit.

Substitute in place of applicant required? (MANDATORY) Select... Yes No Not Applicable Officer Full Name Officer Designation

Office Name