Form GPMD1

DECLARATION BY EMPLOYEE (MOTHER)

GOVERNMENT-PAID MATERNITY LEAVE (GPML) SCHEME/

ADOPTION LEAVE FOR MOTHERS (AL)
SHARED PARENTAL LEAVE (SPL) SCHEME
This form will take about 3 minutes to complete.

Before you start,

i. Please read the scheme information:
• Refer to [Link] for GPML scheme.
• Refer to [Link] for AL scheme.
• Refer to [Link] for SPL scheme.

ii. Please note that apart from Part 8, all references to “you” or “I” in this form shall be taken to be a reference to you, the
applicant, who is applying for Maternity Leave/ Adoption Leave and Shared Parental leave (if applicable).

iii. Please submit a copy of the following documents to your employer for verification, along with this form:
• For biological mother:
o Your child/children’s birth certificate(s)
o Notification of a Stillbirth or Certificate of Registration of Stillbirth (if applicable)
o Singapore citizenship certificate of child (if applicable).
• For adoptive mother:
o Your child/children’s birth certificate(s)
o Court application to adopt (for Singapore Citizen child)
o Dependant’s Pass or document indicating that the application for the dependant’s pass has been approved
(for non-Singapore Citizen child)

All fields and tick boxes are mandatory unless otherwise stated.

Part 1: Parent Details

Name: NRIC / FIN:

Part 2: Child Details

For biological mother

 Biological  Stillbirth

Birth Certificate No.: __________________ Stillbirth Notification / Reg No.: __________________

Note: Parents of stillborn children are not entitled to SPL.

For more information, please refer to the FAQ.

Child Order1:

For adoptive mother

Note: Leave entitlement will be based on the Formal Intent to Adopt (FIA) date. Refer to FAQ to understand what it
means. It also includes details on where to find the various dates required in this form.

1 Refer to FAQ for more details.

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Birth Certificate / Dependant’s Pass2 No.: Date of Adoption Order (if available):

Date when application to adopt child is submitted to Date of Dependant’s Pass issuance (if applicable):
Court:

I am not the biological mother of the child to be adopted.  Yes  No

Part 3: Sharing Arrangement for Shared Parental Leave

My child’s estimated delivery date (EDD), date of birth or FIA date is on or after 1 Apr 2025.  Yes  No

The total Shared Parental Leave weeks shared between me and my spouse (if relevant) do  Yes  No
not exceed the combined entitlement3.

I am taking ______ weeks of Shared Parental Leave.

If the sharing arrangement is amended after 4 weeks from the child’s date of birth/FIA date, please complete and
upload Annex A when submitting the amendment in LifeSG.

Part 4: Citizenship
Biological Child

a. The child in respect of whose birth I am applying for Maternity Leave, and/or Shared  Yes  No
Parental Leave (if applicable) has been, or will be, registered as a Singapore citizen
within 12 months from the date of the child’s birth. 4

Stillborn

b. I was a citizen of Singapore at the time of the child’s delivery.  Yes  No

(If the answer is “Yes”, please skip to Part 4)

c. The child’s father was a citizen of Singapore at the time of the child’s delivery and was  Yes  No
lawfully married to me on or before the child’s delivery.

Adoptive Child (Singapore Citizen or Permanent Resident)

d. The child whom I am adopting is a Singapore citizen/ Permanent Resident and I have  Yes  No
made an application to the Court to adopt the child.

Adoptive Child (Non-Singapore Citizen or Non-Singapore Permanent Resident)

2
“Dependant’s pass” in relation to a child, means a dependant’s pass, issued in respect of the child under regulations made
under the Immigration Act to enable the child to remain, or to enter and remain, in Singapore for the purposes of adoption under
the Adoption of Children Act, and includes a document evidencing that the application for the dependant’s pass has been
approved.
3
If the child’s date of birth or estimated delivery date (or formal intent to adopt date, for adoptive child) is between 1 Apr 2025 to
31 Mar 2026 (both dates inclusive), parents can share up to 6 weeks of leave. If it is on or after 1 Apr 2026, parents can share
up to 10 weeks of leave.
4 A female employee whose child is not a Singapore citizen at the point of birth but meets the 3-month employment criteria

under the Employment Act (EA) is eligible for Maternity Leave under the EA. If the female employee subsequently meets the
citizenship criteria within 12 months from the child’s birth, she will be eligible to take the unconsumed portion of GPML under
the Child Development Co-Savings Act commencing on the date when the citizenship criteria are met and within 12 months
from the child’s birth. Maternity Leave taken under the EA will not be reimbursed by the Government.

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e. The child whom I am adopting was not a Singapore citizen/ Permanent Resident at the  Yes  No
date on which a dependant’s pass (DP) was issued by Ministry of Social and Family
Development in respect of the child.

f. I am making a sole application to adopt the child. I have been a Singapore citizen since  Yes  No
the FIA date.

g. I am making a joint application with my husband to adopt the child. Either I or my husband  Yes  No
have been a Singapore citizen since the FIA date.

Part 5: Employment Period and Leave Consumption

a. Employment period - Please indicate “Yes” to either options (i) or (ii) below.
(i) I have worked with the employer from whom I am applying for Maternity Leave and (if  Yes  No
applicable) Shared Parental Leave, for a continuous period of at least 3 months
preceding the child’s date of birth/FIA.

(ii) I have not worked with the employer for a continuous period of at least 3 months  Yes  No
preceding the child’s date of birth/FIA and was working with the employer at the point of
child’s birth/FIA. However, my employer is agreeable to grant Maternity Leave and (if
applicable) Shared Parental Leave to me.

b. Format of taking leave

For maternity leave – Please indicate “Yes” to either options (i) or (ii) below.
(i) I have sought my employer’s agreement to take Maternity Leave continuously for a  Yes  No
period for a period of 16 weeks, commencing:
1) Not earlier than 28 days immediately preceding the child’s date of birth; and
2) Not later than the child’s date of birth.

(ii) I have sought my employer’s agreement to take Maternity Leave as:  Yes  No
1) A period of 8 weeks taken continuously, commencing:
a. Not earlier than 28 days immediately preceding the child’s date of birth;
and
b. Not later than the child’s date of birth; AND
2) Remaining 8 weeks taken non-continuously, within 12 months commencing on the
child’s date of birth.

Alternatively, if both parties are unable to reach agreement on the leave format, the employee may take Maternity
Leave continuously for a period of 16 weeks, commencing 4 weeks immediately before child’s date of birth.

For adoption leave – Please indicate “Yes” to either options (i) or (ii) below.
(i) I have sought my employer agreement to take Adoption Leave continuously for a  Yes  No
period of 12 weeks, commencing:
1) Not earlier than the date of the FIA; and
2) Not later than the date the adoption order is made.

(ii) I have sought my employer agreement to take Adoption Leave as:  Yes  No
1) A period of 8 weeks as agreed with my employer, commencing:
a. Not earlier than the date of the FIA; and
b. Not later than the date the adoption order is made.
2) Remaining 4 weeks taken non-continuously, within 12 months commencing on the
child’s FIA.

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Alternatively, if both parties are unable to reach agreement on the leave format, the employee may take Adoption
Leave continuously for a period of 12 weeks, commencing from the FIA date.

For shared parental leave (if applicable)

(i) I will take my Shared Parental Leave after my Maternity Leave/Adoption Leave is fully  Yes  No
consumed.

(ii) I have sought my employer’s agreement to take Shared Parental Leave (i.e. N weeks  Yes  No
allocated to me in sharing arrangement) non-continuously, within 12 months
commencing on the child’s date of birth.

Alternatively, if both parties are unable to reach agreement on the leave format, the employee may take Shared
Parental Leave continuously within 26 weeks, commencing on the child’s date of birth and after Maternity
Leave/Adoption Leave is fully consumed.

Part 6: Concurrent multiple employment

(i) I am working concurrent multiple employment.  Yes  No

(If the answer is “No”, please skip to Part 7.)

(ii) I understand that if the total claim amount submitted by the multiple employers exceeds  Yes
the reimbursement limit, my employer may clawback a portion of salary paid after
reimbursement from MSF.

For more information, please refer to the FAQ.

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Part 7: Declaration by Employee

❑ I hereby declare that all information given in this declaration is true, correct and complete.

❑ I understand that:-
a) it is an offence under the Child Development Co-Savings Act to knowingly make any false or misleading
statement, provide, or cause or knowingly allow to be provided, any document or information which I know
to be false or misleading in a material particular, such offence being punishable with a fine not exceeding
$20,000 or to imprisonment for a term not exceeding 12 months or to both; and that upon conviction of such
offence, the court may, in addition to the prescribed punishment, order me to make restitution of any moneys
paid out to me by the Government in reliance of the false or misleading statement, document or information,
as the case may be; and

b) my employer or the Government may recover from me any moneys paid out to me in reliance of any false
or misleading statement, document or information, or by any error (however caused).

❑ (applicable only for adoptive mother) I further understand that my employer/the Government may recover the
whole or any part of the payment for the Adoption Leave and (if applicable) Shared Parental leave
reimbursed/granted if:-
a) the child is not adopted within 12 months commencing on the date of the FIA; or
b) the child is not a Singapore citizen by birth, and does not become a citizen of Singapore within 6 months
commencing on the date the child is adopted.

Name NRIC / FIN Signature & Date

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Part 8: Employer’s Acknowledgement

a. I am satisfied that my employee is eligible for Maternity Leave/Adoption Leave and (if  Yes  No
applicable) Shared Parental Leave.

If the employee indicated “No” in Part 1-5, please be reminded to verify his eligibility as
he may not be eligible.

b. I understand and am aware that my employee must complete Maternity Leave/Adoption  Yes  No
Leave before taking Shared Parental Leave.

c. I have agreed to allow my employee to take her Maternity Leave/Adoption Leave as per  Yes  No
Part 5 above.

Name & Designation NRIC / FIN Company Name Signature & Date

Note to employer:
This declaration form is to guide you in verifying the employee’s eligibility for Government-Paid Leave
Schemes (GPLS). You are not required to submit this form when submitting the claim for reimbursement.

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Annex A: Proof of employer agreement template

For amendments to Shared Parental Leave (SPL) Sharing Arrangement

Note to employee:

If you wish to change your SPL sharing arrangement 4 weeks or more after your child’s Date of
Birth (or Formal Intent to Adopt date - for adoptive children), you will need to upload proof
showing that your employer agrees with your revised SPL sharing arrangement.

You may provide other forms of agreement instead of this template, e.g. an official letter of
approval, screenshots of emails between you and your employer, or documentation from your
HR portal.

Part A: Employee’s Declaration

❑ I am changing my sharing arrangement* from _________ weeks to ________ weeks of Shared Parental
Leave.

Employee’s Name Employee’s Child’s Birth Signature & Date

NRIC / FIN Certificate No.

Part B: Employer’s Acknowledgement

❑ I have agreed to allow my employee to change Shared Parental Leave as per Part A above.
❑ I understand that I will only be able to claim for leave taken by the employee within the allocated weeks in the
sharing arrangement.

Name & NRIC / FIN Company Name Signature & Date

Designation

* If the child’s date of birth or estimated delivery date (or formal intent to adopt date, for adoptive child) is between 1 Apr 2025 to
31 Mar 2026 (both dates inclusive), the total leave that the parents can share in their sharing arrangement is up to 6 weeks of
leave. If it is on or after 1 Apr 2026, parents can share up to 10 weeks of leave.

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