Bereavement Leave Request
HR-013
Page 1 of 1
Employee
Employee Name
Employee ID
Dates
Start Date
End Date
Total Days
Relation
Relationship to Deceased
Decision
Approve
Deny
Needs More Information
Employee Signature
Manager Signature
Date
Confidential · Acme Corporation HR
HR-013 · Bereavement Leave Request · Page 1 of 1
