Sarkari Dak - Government Tools Portal

APPLICATION FOR CHILD CARE LEAVE

1. Name of the Applicant

2. Designation

3. Dept/Office/Section

4. Name of Child (for CCL)

5. Date of Birth of Child

6. Date child attains 18 years

7. Among two eldest children?

8. EL in credit (as on date)

9. Period of Leave

Days

From Date

To Date

Prefix/Suffix of holidays

10. Reason(s) for leave applied for

11. Total CCL availed till date

12(a). Station leave required?

12(b). Address during leave

13. Date of return from last leave & nature

Pay Card No.