Attachment_4_Bereavement_Leave_Certification.doc
DOC document 31 KB Posted
- Solicitation number
- HDEC08-15-R-0025
- Issued by
-
Defense Commissary Agency
About this file
Bereavement Leave Certification
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Attachment 4
HDEC08-15-R-0025
ATTACHMENT 4
BEREAVEMENT LEAVE CERTIFICATION
REQUEST FOR PAYMENT
Contract:____________________________________
Name of Employee:____________________________
Area of Operation (circle one) Shelf Stocking RSHA Custodial
Name of Deceased:____________________________
Relationship to Employee:______________________
Dates of Bereavement Leave:____________________
I certify that the above named individual took Bereavement Leave in accordance with the provision of the Collective Bargaining Agreement (CBA) applicable to abovementioned contract and that the individual was paid according to its provisions. Pursuant to said agreement, the contractor is entitled to reimbursement.
| _________________________________ |
| (Signature) |
| _________________________________ |
| (Name, Position, and Date) |
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