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Bereavement leave application form Application form to be used by employees to apply for bereavement 2026

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4.9 out of 5

46 votes

The document is a Bereavement Leave Application Form (HR 108 (d)) for employees to request time off due to the death of a relative. It outlines the necessary information to be filled by the employee and their line manager, including details about the deceased and the duration of leave requested. The form also references HSE HR Circular 029/2019, which specifies the leave entitlements based on the relationship to the deceased, with up to twenty working days for immediate family members and provisions for exceptional circumstances. Additional guidelines on approval and documentation are provided.

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Click ‘Get Form’ to open the Bereavement Leave Application Form in the editor.
Begin by filling in your personal details: Surname, First Name, Grade, Personnel No, Location, and PPS No. This information is essential for processing your application.
Indicate your relationship to the deceased by selecting from the options provided (e.g., Father, Mother, Spouse).
Enter the Date of Death and specify the number of days leave you are applying for. Clearly state the start and end dates of your requested leave.
Sign and date the form at the bottom to confirm your application before submitting it.
If applicable, ensure that your Line Manager completes their section by reviewing supporting documentation and approving or denying your request.

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Versions	Form popularity	Fillable & printable
2019	4.9 Satisfied (46 Votes)
2014	4 Satisfied (29 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to apply for a bereavement leave?

How to ask for bereavement leave Notify your employer as soon as possible. Review your bereavement leave policy. Determine how much time off you want and make a timeline. Make a written request for bereavement leave. Supply relevant forms and documentation. Prepare workplace notes.

What qualifies as bereavement?

Make a written request for bereavement leave A written leave request provides both you and your employer with a reference point during and after your leave. While a formal letter is typically the best approach, an email may also be acceptable depending on your company culture .

What is a bereavement form?

In order to take action on the estate, youll need to complete our bereavement form. This form is for the executor of the will, the administrator of the persons estate or the next of kin to complete. We will guide you through the process. Its helpful to have your information and documents ready before you start.

What can be used as proof for bereavement?

This documentation may be in the form of a death certificate, obituary, or written verification of death, burial, or memorial service from a mortuary, funeral home, burial society, crematorium, religious institution, or government agency.

How do I tell my boss I want a bereavement?

For example, if your loved one died while committing a serious crime that harmed others. Or it might be the loss of someone where your relationship is not validated or understood by others. For example, if your family dont know about your partner or dont accept them.

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How to request a bereavement leave template?

Todays Date: Employee: Supervisor: I am requesting bereavement leave due to the death of a family member/relative as follows: Dates and hours requested: