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Notice of Bereavement Leave - Template, Sample Form Pro · EN-CA-law

✓ Valid in Canada (English) · drafted to comply with local law

Create your Notice of Bereavement Leave - Template, Sample Form for use in Canada (English). Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share. This version has been professionally rewritten to comply with local law.

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Notice of Bereavement Leave - Template, Sample Form
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Re: Notice of Bereavement Leave

Dear ________,

§ 1. Purpose of Notice. Please accept this letter as my formal written Notice of Bereavement Leave. My ________, namely ________, has recently passed away. I require this time to grieve, to attend to family matters arising from this loss, and to prepare for and attend the funeral and related observances.

§ 2. Statutory Basis. This is a statutory leave taken pursuant to the bereavement leave provisions of the Canada Labour Code (R.S.C., 1985, c. L-2), Part III, and the regulations made thereunder, to the extent my employment falls within federal jurisdiction. To the extent my employment is provincially regulated, this notice is given pursuant to the applicable employment standards legislation of the province of ________ and the regulations made thereunder.

§ 3. Period of Leave. I intend for my leave of absence to commence on ________. I anticipate requiring ________ day(s) of leave. I understand that a portion of this leave may be paid in accordance with my length of continuous employment and the applicable statutory provisions, and I request that any such entitlement be applied accordingly.

§ 5. Proof of Entitlement. Should ________ reasonably require proof in respect of this leave, I am prepared to provide such documentation as is reasonable in the circumstances, including an online funeral home notice or published obituary in respect of ________.

§ 7. Contact and Return. If any further information regarding my leave of absence is required, please do not hesitate to leave me a voicemail or email, and I will respond as soon as practicable. Should I not be in touch during my leave, I plan to return to work on ________ and may be available to discuss any outstanding matters upon my return.

Thank you for your understanding and consideration during this difficult time.

Sincerely,





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