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izkFkhZ ds gLrk{kj ¼frfFk ds lkFk½

14- fu;a=.k vf/kdkjh dh vH;qfDr;ka vkSj@;k flQkfj'k

vf/kdkjh ds gLrk{kj ¼frfFk ds lkFk½

NORTH DELHI MUNICIPAL CORPORATION FORM OF APPLICATION FOR CHILD CARE LEAVE Note: Item 1 to 13 must be filled in by all applicants whether gazette or no-gazetted

1. Name of applicant........................................................................................... 2. Post held.......................................................................................................... 3. Department Office and Section....................................................................... 4. Pay................................................................................................................... 5. Total number of Children................................................................................. 6. Name and Date of Birth of the first child......................................................... ..................................................................................................................... 7. Name and Date of Birth of the second child.................................................... ..................................................................................................................... 8. Whether leave is applied for First child or Second child.................................. ..................................................................................................................... 9. Period of leave applied and date from which required. ..................................................................................................................... 10. Sundays and holidays, if any, proposed to be-fixed/suffixed to leave………… ........................................................................................................................ 11. Ground on which leave is applied for ........................................................... 12. Date of return from last leave, and period of that leave .................................................................................................................... 13. Address during leave.......................................................................................

Signature of the applicant (with date) 14. Remark and/or recommendation of the controlling officer Signature of the Office (with date)