Applicant’s name:
Department / Workplace:
Study branch:
I hereby ask for registration of recognized parental leave in accordance with paragraph 21 article 1 letter f) of Act no. 111/1998 Sb. as amended
valid as of:				to:		

On the grounds of:
-	child’s birth on:
-	expected child’s birth, expected birth data is set for:
-	taking custody of child on:

I prove these claims by:
-	copy of child’s birth certificate
-	copy of pregnancy card
-	copy of court ruling on taking custofy of child

At the same time, I request/do not request that my study be interrupted
as of:				to:

Address of doctoral student:

Signature of doctoral student: