Att_4_-_BEREAVEMENT_LEAVE_CERTIFICATION.doc
DOC document 28 KB Posted
- Solicitation number
- HDEC08-16-R-0001
- Issued by
-
Defense Commissary Agency
About this file
Attachment 4 Bereavement Leave Certification
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Text version
ATTACHMENT 4
HDEC08-16-R-0001
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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