[{"id":"746a0433-1bde-4f1b-a2f8-fdd04e664ba2","order":1,"text":"STATUTORY ADOPTION LEAVE AND PAY","fontSize":"22","textAlign":"center","bold":true,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"f930a5d3-763e-439b-aab5-8c1df892f5c8","order":2,"text":"NOTICE OF ADOPTION LEAVE AND REQUEST FOR STATUTORY ADOPTION PAY","fontSize":"16","textAlign":"center","bold":true,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"084954fc-bebb-401d-9586-86a79988ddd6","order":3,"text":"Given pursuant to the Paternity and Adoption Leave Regulations 2002 and the Statutory Paternity Pay and Statutory Adoption Pay (General) Regulations 2002","fontSize":"12","textAlign":"center","bold":false,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"94a97527-2a84-444c-a440-70d79a0110f3","order":4,"text":"FAO: HR / Payroll Department
[Employer name]
[Employer address]","fontSize":"14","textAlign":"right-align","bold":false,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"f3cdc0af-5a3f-4e88-837f-143cf26f6b46","order":5,"text":"From: [Employee name] ([Job title], [Department])","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"b1fddbd4-5164-4645-8778-82c7cccb0ca5","order":6,"text":"Date of this notice: [Date of notice]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"e5c3032b-0b43-4fb5-8e76-47a0f5515296","order":7,"text":"Dear Sir or Madam,","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"14","cflou":false,"active":true},{"id":"b38991ea-e9dd-4a96-a895-d9ec3e14cd0b","order":8,"text":"I am writing to give you formal written notice of my intention to take Statutory Adoption Leave, and to claim Statutory Adoption Pay, in connection with the placement (or expected placement) with me of a child for adoption. I set out below the particulars required to enable you to record my leave, calculate and administer my pay, and confirm the agreed dates in writing for payroll, handover and planning purposes.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"cf68cdfd-00b1-4a11-b995-71f57caf9b31","order":9,"text":"1. EMPLOYEE PARTICULARS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"6","sectionNum":"S01"},{"id":"6f27c407-1750-4f18-ac3f-11dcaeaaca10","order":10,"text":"Full name: [Employee name]. Job title: [Job title]. Department: [Department].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"340f2ac4-1e82-4bb9-8b49-4a3db71b952f","order":11,"text":"Payroll / staff number: [Payroll number]. National Insurance number: [National Insurance number].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"e06fb6aa-540b-4f04-a029-99c58999d676","order":12,"text":"Home address: [Home address]. Contact email: [Email].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6558256b-df46-4a2f-967b-9119f951aab9","order":13,"text":"I confirm that I have been continuously employed by you since [Continuous employment start date] and, to the best of my knowledge, satisfy the qualifying conditions for the entitlements claimed in this notice.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"b96d9a55-5a7e-4c60-9d4d-34ead9f4a1ff","order":14,"text":"2. THE ADOPTION ARRANGEMENT","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S02"},{"id":"4f2fb874-b8fc-4130-9dd0-30686b5d36b9","order":15,"text":"The adoption is being arranged through [Adoption agency name], an adoption agency recognised in the United Kingdom, of [Adoption agency address].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"c03bc000-5b68-4cdc-9ac3-bf959ada743d","order":16,"text":"I have been matched with a child (or children) for adoption by the said agency. I was notified of the match on [Date of matching], and a copy of the matching certificate issued by the agency is enclosed with this notice as documentary evidence of the arrangement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"overseas","type":"remove","operator":"="},{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"surrogacy","type":"remove","operator":"="}]},{"id":"43ed9833-23eb-4434-8071-d372dca9041b","order":17,"text":"The number of children being placed with me under this arrangement is [Number of children].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"overseas","type":"remove","operator":"="},{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"surrogacy","type":"remove","operator":"="}]},{"id":"bcee119b-d812-433a-84fe-c3d662a9f798","order":18,"text":"This is an adoption of a child from overseas. I received official notification from the relevant authority that I am eligible to adopt, and have been matched with the child, on [Official notification date]. The child is expected to enter the United Kingdom on or about [Expected date of entry to the UK]. Documentary evidence of the official notification is enclosed with this notice.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"overseas","type":"add","operator":"="}]},{"id":"58fb2c86-0645-4900-b012-9253af6c3433","order":19,"text":"I am an intended parent under a surrogacy arrangement and expect to become the child's parent by way of a Parental Order. I have applied, or will apply within six months of the birth, for a Parental Order in respect of the child and expect the court to grant such an Order. The expected week of the child's birth is [Expected week of birth].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"surrogacy","type":"add","operator":"="}]},{"id":"da264d68-59d9-4022-9617-8c90562efa4e","order":20,"text":"The expected date of placement (the date on which the child is expected to start living with me) is [Expected placement date].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"overseas","type":"remove","operator":"="},{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"surrogacy","type":"remove","operator":"="}]},{"id":"4734e38b-6b5b-43fa-8d03-2783731d002b","order":21,"text":"The expected date of placement (the date on which the child is expected to start living with me) is [Expected placement date].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"surrogacy","type":"add","operator":"="}]},{"id":"49e8ea95-d34c-4e17-81fc-f6551b6a84e4","order":22,"text":"3. STATUTORY ADOPTION LEAVE","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S03"},{"id":"ff14be23-9d8a-4f79-968b-f5dca4162da8","order":23,"text":"I hereby give notice that I intend to take my full entitlement to Statutory Adoption Leave of up to 52 weeks, comprising 26 weeks of Ordinary Adoption Leave followed immediately by 26 weeks of Additional Adoption Leave. I understand that, where I am adopting jointly with another person, only one member of the couple may take adoption leave as the main adopter.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"decbc6a1-4175-4364-bda7-955a9e8f8635","order":24,"text":"I have elected to be the main adopter for the purposes of Statutory Adoption Leave and Pay, my partner intending (if eligible) to take paternity leave and pay in respect of the same child.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"a48a8010-970d-422d-ae55-ac1f7e79e4e9","value":"1","type":"add","operator":"="}]},{"id":"b16664ea-4158-44dc-84d8-f6fed02d0fdc","order":25,"text":"I wish my Statutory Adoption Leave to commence on [Adoption leave start date]. I confirm that this date is not earlier than 14 days before the expected date of placement.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"69e148aa-34bf-430c-9a27-3e98691a064d","order":26,"text":"On the basis of that start date, my 26 weeks of Ordinary Adoption Leave are expected to end on [Ordinary Adoption Leave end date], and my Statutory Adoption Leave is expected to end in full on [Adoption leave end date]. Unless I notify you otherwise in accordance with the statutory notice requirements, I intend to return to work on [Intended return-to-work date].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"2df615b0-f9b9-4a32-bfdd-92d759b04ee9","order":27,"text":"I request that, within 28 days of receiving this notice, you confirm to me in writing the date on which my Additional Adoption Leave will end, so that the agreed dates are recorded for payroll, handover and planning purposes. I reserve the right to change my chosen leave start date by giving you not less than 28 days' written notice (or as much notice as is reasonably practicable), and to vary my return date by giving not less than 8 weeks' written notice of an earlier return.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"a0802ca7-f1ed-4355-add0-1b0f39f70104","order":28,"text":"4. STATUTORY ADOPTION PAY","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S04"},{"id":"f3092567-2469-47a0-ad89-b30698046763","order":29,"text":"I claim Statutory Adoption Pay (SAP) for the maximum period of 39 weeks for which I am entitled. I understand that SAP is payable at 90% of my average weekly earnings for the first 6 weeks, and thereafter at the lower of the prescribed statutory weekly rate or 90% of my average weekly earnings for the remaining 33 weeks, subject to deduction of income tax and National Insurance contributions, and subject to my satisfying the qualifying conditions (including the lower earnings limit) by reference to the relevant period ending with the matching week.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"b2cb6f2a-b643-4daf-8a7c-4d1fe3ba54e3","order":30,"text":"I wish payment of Statutory Adoption Pay to begin on the date the child is placed with me (or, where applicable, the date the child enters the United Kingdom).","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"ab972ec2-c6f0-4e16-8b27-430454751ead","value":"placement","type":"add","operator":"="}]},{"id":"6280270a-f1ab-4a56-9b41-0e95c4c9e0d3","order":31,"text":"I wish payment of Statutory Adoption Pay to begin on [Statutory Adoption Pay start date]. I confirm this date is not more than 14 days before the expected date of placement and not later than the date of placement itself.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"ab972ec2-c6f0-4e16-8b27-430454751ead","value":"before","type":"add","operator":"="}]},{"id":"23dbae61-d94f-48f9-9bdc-3d0aa8be7476","order":32,"text":"I undertake to notify you promptly of the actual date of placement (and, for an overseas adoption, the actual date on which the child enters the United Kingdom) so that the adoption pay period can be administered correctly. I acknowledge that, should the placement not take place, or the adoption be disrupted, my entitlement will be administered in accordance with the applicable statutory provisions.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"4bf14ae6-9643-4d2b-9fe1-bc3ac395603a","order":33,"text":"5. CONTRACTUAL ADOPTION SCHEME","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S05"},{"id":"54ab082e-4285-4e38-9a9b-eedbc5e64db7","order":34,"text":"I have not identified any contractual adoption scheme more favourable than the statutory minimum that applies to me. Should such a scheme apply, I reserve the right to rely upon it in addition to my statutory entitlements.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"bb1a8b46-9958-4b5b-b009-c120275a96a4","value":"1","type":"remove","operator":"="}]},{"id":"d6ca6f2d-8bf1-4020-a0a2-e9fb487e5f56","order":35,"text":"I understand that you operate a contractual adoption leave and pay scheme that is more favourable than the statutory minimum. I request that any enhanced entitlement under that scheme be applied in addition to, and not in substitution for, my statutory entitlements. The relevant enhanced terms I am relying upon are: [Enhanced scheme terms].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"bb1a8b46-9958-4b5b-b009-c120275a96a4","value":"1","type":"add","operator":"="}]},{"id":"ff4d6281-aa9a-4520-830f-5275f4665898","order":36,"text":"Nothing in this notice shall be taken to waive or reduce any contractual entitlement, and any enhanced payment shall be offset against, and inclusive of, the statutory amounts payable for the same period save where the scheme expressly provides otherwise.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"bb1a8b46-9958-4b5b-b009-c120275a96a4","value":"1","type":"add","operator":"="}]},{"id":"bcc43457-b003-4305-b66b-b7aab245ac2f","order":37,"text":"6. KEEPING IN TOUCH DAYS","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S06"},{"id":"0e15df1e-f695-4101-bfc4-c6a01aeb98d2","order":38,"text":"I understand that I may, by agreement with you and without bringing my adoption leave to an end or losing Statutory Adoption Pay, work for you for up to 10 Keeping in Touch (KIT) days during my Statutory Adoption Leave, the rate of pay for any such days to be agreed between us. I am under no obligation to work any KIT days, and you are under no obligation to offer them.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"41c4ad82-369f-48cd-8554-37b92769e924","order":39,"text":"Subject to operational requirements and to separate agreement nearer the time, I anticipate that I may wish to make use of approximately [Anticipated number of KIT days] Keeping in Touch days during my leave.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"bb036f2a-1d24-4b13-a92b-f3dc874e084e","value":"1","type":"add","operator":"="}]},{"id":"21c04bc6-715c-434c-84eb-db74b7293727","order":40,"text":"7. SHARED PARENTAL LEAVE AND PAY","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S07"},{"id":"8ad8e2aa-f47d-4380-a7f9-9ce55687459a","order":41,"text":"I do not, at the date of this notice, intend to opt into Shared Parental Leave in respect of this child. Should my intention change, I will provide the separate statutory notices required to curtail my adoption leave and to book Shared Parental Leave within the prescribed time limits.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"4efef890-ed37-4b5a-8df5-be10edb3ad4e","value":"1","type":"remove","operator":"="}]},{"id":"0d3d8091-98fd-4fc4-bcb5-1a47eee3d502","order":42,"text":"I wish to record that I may, in due course, elect to bring my Statutory Adoption Leave to an end early and to opt into Shared Parental Leave and Statutory Shared Parental Pay with my partner in respect of the same child. This notice is given without prejudice to, and does not constitute, the separate statutory notices required to curtail adoption leave and to book Shared Parental Leave, which I will provide in the prescribed form and within the prescribed time limits should I decide to proceed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"4efef890-ed37-4b5a-8df5-be10edb3ad4e","value":"1","type":"add","operator":"="}]},{"id":"82a18d94-c4cf-4e2e-bb02-f1d18a563e24","order":43,"text":"8. RIGHTS DURING AND AFTER LEAVE","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S08"},{"id":"6dee60ac-ffe3-4e9d-b930-ad527034f481","order":44,"text":"I understand and expect that, during my Statutory Adoption Leave, all the terms and conditions of my employment (other than terms as to remuneration) will continue, that my continuity of employment will be preserved, and that I will continue to accrue annual leave in accordance with my contract and the Working Time Regulations 1998.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"643c144c-024e-42d6-83a8-dd066a6dbbd5","order":45,"text":"I expect to return, following Ordinary Adoption Leave, to the same job on the same terms and conditions, and, following Additional Adoption Leave, to the same job or, where that is not reasonably practicable, to a suitable and appropriate alternative role on terms and conditions no less favourable than those which would have applied had I not been absent.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"52f0287b-6091-4973-8fb0-fedc6eaecd3f","order":46,"text":"I further understand that I am entitled to the protection afforded to employees on adoption leave, including in any redundancy situation the right to be offered any suitable available vacancy in priority, and protection from detriment or dismissal by reason of having taken or sought to take adoption leave.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"46c6fb05-070e-4ce3-ba0a-b4f55aae4f29","order":47,"text":"9. DATA PROTECTION","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S09"},{"id":"cf670861-c42d-445a-844f-1acdb3948eea","order":48,"text":"I consent to your processing of the personal data (including any special category data relating to the adoption and the child) contained in this notice and its enclosures for the sole purposes of administering my adoption leave and pay, complying with your statutory obligations to HM Revenue & Customs, and maintaining accurate payroll and personnel records, in accordance with the UK General Data Protection Regulation and the Data Protection Act 2018. I ask that such data be retained only for as long as is necessary for those purposes and the applicable statutory retention periods.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"348a0a23-55bb-4ab7-aea9-cc943305ca10","order":49,"text":"10. DECLARATION AND ENCLOSURES","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S10"},{"id":"85ca0d7d-5df9-4285-8907-8a8c7a057775","order":50,"text":"I declare that the information given in this notice is true and complete to the best of my knowledge and belief. I enclose, as documentary evidence of the adoption arrangement, the matching certificate (or, in the case of an overseas adoption, the official notification, and in the case of a surrogacy arrangement, a statutory declaration in support of the Parental Order). I will provide any further information or completed forms (including form SC4 or SC6 where applicable) reasonably required to process my entitlements.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"9fa2764c-e020-49e6-b0a8-0da6b446d758","order":51,"text":"I should be grateful if you would acknowledge safe receipt of this notice and confirm the agreed leave start date, the date my Additional Adoption Leave will end, my intended return date, and the arrangements for Statutory Adoption Pay, in writing, within 28 days.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"ea38ee0b-8915-4aba-966f-0ab65820b912","order":52,"text":"Yours faithfully,","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"24","cflou":false,"active":true},{"id":"1ddd9937-b55a-4a8f-b02d-21a8318cbfce","order":53,"text":"Signed: ............................................................","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"b3d48a7b-cf29-4822-b71e-8d38708c70ff","order":54,"text":"[Employee name]","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"4","cflou":false,"active":true},{"id":"13b0cca6-bd03-4d90-bcb3-424c32a37b5b","order":55,"text":"Date: [Signature date], at [Place of signature].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"bc6a68f0-54a5-4a1a-b5ba-d94514dc5528","order":56,"text":"EMPLOYER ACKNOWLEDGEMENT (for completion by the employer)","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"a25f3f11-bba7-45c4-970e-9b6f186ffd1b","order":57,"text":"We, [Employer name], acknowledge receipt of the above notice from [Employee name]. We confirm the agreed Statutory Adoption Leave start date of [Adoption leave start date], that Additional Adoption Leave is due to end on [Adoption leave end date], and that the matching date recorded is [Date of matching].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"overseas","type":"remove","operator":"="},{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"surrogacy","type":"remove","operator":"="}]},{"id":"65cfb537-9ab0-42ec-9ef1-2b2f4ec3ecab","order":58,"text":"We, [Employer name], acknowledge receipt of the above notice from [Employee name]. We confirm the agreed Statutory Adoption Leave start date of [Adoption leave start date] and that Additional Adoption Leave is due to end on [Adoption leave end date].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"f74582c1-3d5a-42cf-9492-d780bf776e72","value":"domestic","type":"remove","operator":"="}]},{"id":"16eee89a-9955-41da-855d-0dc3c062b0b5","order":59,"text":"Signed for and on behalf of the employer: ...................................................... Date: ......................","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"4","cflou":false,"active":true}]