ECCE REf no:______

(Existing provider)

Settling In Transfer Form ECCE to CCS

Part A – To be completed by existing Pre-school Service (BLOCK CAPITALS)

I, ______Manager/Owner (circle as approp.)

at ______Pre-school, ECCE Ref No: ______

where ______has been attending theECCE Programme, for ___ days a week.

This child last attended on / I have been informed that s/he will not be attending this service from

Date:_____/_____/_____ and understand that no further capitation will be paid by DCYA to this

service in respect of this child fromDate:_____/______/____

(ECCE payment date - not later than28/09/2012).

Signed ______Date:____/____/____

Part B – To be completed by Parent/Guardian (BLOCK CAPITALS)

I,______Parent/Guardian of ______

Child’sPPS No. is ______, apply for his/her ECCE capitation tocease. I wish to join the

CCS ______Service, effective from Date::_____/______/____.

I declare that this child is notcurrently being supported in the CCS or CETS programmeat this time. Please note that if the child is of eligible age for the ECCE programme next year, the child will not be able to access the ECCE programme unless a deferral form is completed and the first service is reimbursed by the parent. This transfer will not be permitted if a CCS Parent Declaration form is not completed before the 17 October 2012deadline and if the child is not entered on the CCSservice’s e-return.

Signed ______Date:____/____/_____

Part C – To be completed by the CCS Service (BLOCK CAPITALS)

I, ______,Manager at______

______Service CCS Ref.No:______, have allocated a __days per week______

(full/part/sess/half sess) place onthe CCSProgramme to the above child from Date:___/____/____.

(Date not earlier than ECCE payment date as specified in Part A above and no later than the CCS e-return)

This transfer will not be permitted if the child is not entered on the CCS e-return for this CCS service.

Signed ______Date:___/____/_____

CCS Form 4 – Settling In Transfer Form ECCE to CCS13/09/2018