[{"id":"e615556e-3003-46c8-8920-4749b6c50e70","order":1,"text":"[Your full name]","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"9cc7d40d-b2ea-4897-84d7-d88602f895fc","order":2,"text":"[Your job title]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"154bcdc8-b3e4-419a-813d-b9667baa2ea2","order":3,"text":"[Your department / team]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"fc06642e-bb83-40f9-9d91-4d1e4bd665f3","order":4,"text":"Employee / payroll number: [Employee / payroll number]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"0b7c53da-a60b-4329-a3f0-2ab84dfa4477","order":5,"text":"[Your work email] — [Your contact telephone]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"6268493d-bef3-40fc-88ba-fa050ba77652","order":6,"text":"[Recipient name]
[Recipient role (e.g. HR Manager)]
[Employer / organisation name]
[Employer address]
[Town / city], [Postcode]","fontSize":"14","textAlign":"right-align","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"ef171fae-5d12-465e-ac2e-8849dc4faaf9","order":7,"text":"[Town / city of writing], [Date of this letter]","fontSize":"14","textAlign":"right","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"830f8454-b11e-4ef8-98a2-9a8879026e13","order":8,"text":"Subject: Request for [Leave type (auto)] and confirmation of the agreed dates in writing","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"d97e8eee-8bb9-450b-8b19-b738f70e8188","order":9,"text":"Dear [Recipient name (salutation)],","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"f712de4f-7dbb-48e3-a31f-afcae9b0824a","order":10,"text":"I am writing to formally request a period of statutory parental bereavement leave following the death of my child, and to ask that the dates set out below be confirmed in writing so that payroll, my line manager and the wider team can plan accordingly. I should be grateful if you would treat this letter as my formal notice under Jack's Law (the Parental Bereavement (Leave and Pay) Act 2018) and the related Regulations.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"compassionate leave","type":"remove","operator":"="}]},{"id":"54384ef0-1dce-4113-ba69-f2a2fa4f96aa","order":11,"text":"I am writing to formally request a period of compassionate / bereavement leave following a recent family bereavement, and to ask that the dates set out below be confirmed in writing so that payroll, my line manager and the wider team can plan accordingly. I am raising this request in good faith and as early as my circumstances have reasonably allowed.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"statutory parental bereavement leave","type":"remove","operator":"="}]},{"id":"ebe66791-19fc-4c2a-9740-0dcff25241f1","order":12,"text":"The bereavement","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"c9197725-f8a7-4472-b998-179644c4216b","order":13,"text":"The bereavement concerns [Full name of the deceased], who was my [Your relationship to the deceased]. The death occurred on [Date of death].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"5026dc42-de79-45c1-b046-0c1fe4d84925","order":14,"text":"My child was under the age of 18 at the date of death (or the loss occurred as a stillbirth after 24 weeks of pregnancy, or as a miscarriage before 24 weeks where the right applies from 6 April 2026). I confirm that I am a person to whom statutory parental bereavement leave is available, being the child's parent or a person with parental responsibility, an adoptive or intended parent, or a partner living with the child in an enduring family relationship.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"compassionate leave","type":"remove","operator":"="}]},{"id":"1e8aefe5-6ba9-40e2-9979-47e788d66af5","order":15,"text":"I am providing this information solely to support my request. I would ask that it be treated sensitively and in confidence, and shared only with those who genuinely need it in order to administer my leave and pay.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"350cd94c-1717-4714-9b2c-ea5e5b0ecdac","order":16,"text":"Basis of the request","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"301a83ac-ae31-46e2-8933-1139df986d36","order":17,"text":"I understand this leave to be a statutory entitlement. Statutory parental bereavement leave is a day-one right of up to two weeks, which may be taken as a single block of two weeks or as two separate blocks of one week, and which must be taken within 56 weeks of the date of death, stillbirth or qualifying loss.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"compassionate leave","type":"remove","operator":"="}]},{"id":"c084b10d-a78e-4914-acdf-3a48bc07ff7d","order":18,"text":"I understand this leave to be provided under [Basis (auto)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"statutory parental bereavement leave","type":"remove","operator":"="}]},{"id":"556ec5bc-32b5-468d-ade3-b1d75262bdb6","order":19,"text":"I make this request in reliance on the relevant clause of my contract of employment and / or the employer's published compassionate / bereavement leave policy, a copy of which I have reviewed. Where the policy sets out a contractual entitlement, I ask that it be applied; where it is silent or expressed to be discretionary, I ask that discretion be exercised reasonably and compassionately in the circumstances described above.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"statutory parental bereavement leave","type":"remove","operator":"="}]},{"id":"391b273b-f6f3-4192-b2e2-4134480da7cb","order":20,"text":"Separately, and in any event, I reserve my statutory right under section 57A of the Employment Rights Act 1996 to take a reasonable amount of unpaid time off to deal with an emergency involving a dependant, including making arrangements following the death of a dependant.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"statutory parental bereavement leave","type":"remove","operator":"="}]},{"id":"822c9b6c-4c45-4440-ae22-69ef0647d63b","order":21,"text":"Dates and pattern of leave requested","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"04459e2a-0300-47a6-b6c2-4c7ab6f5fd90","order":22,"text":"I request that my leave begin on [Requested start date]. The pattern of leave I am requesting is [Pattern (auto)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"6c133d8d-8750-4778-8ee0-9e95d45759df","order":23,"text":"I request to take the leave as a single continuous block, ending on [Requested end date], returning to work on the next working day thereafter.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9af722fb-b660-4bc8-a2fc-22b5ce1446ff","value":"a single continuous block","type":"add","operator":"="}]},{"id":"667468a1-9097-4418-bde3-414b50fddc5d","order":24,"text":"I request to take the leave as two separate blocks of one week each. The first block is set out above; I will give you the dates of the second block by separate written notice, giving at least one week's notice where the second block falls more than eight weeks after the date of death, in accordance with the applicable notice requirements.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9af722fb-b660-4bc8-a2fc-22b5ce1446ff","value":"two separate blocks of one week","type":"add","operator":"="}]},{"id":"ed2a9aa2-6bba-463b-a631-ec882a0768f0","order":25,"text":"I request to take the leave on a phased basis. I would welcome a short discussion to agree how the days are arranged so as to balance my needs with those of the team, and I will confirm the agreed arrangement in writing.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"9af722fb-b660-4bc8-a2fc-22b5ce1446ff","value":"a phased arrangement to be agreed","type":"add","operator":"="}]},{"id":"53a26297-22c8-4dde-930a-a2f41958c4a3","order":26,"text":"Pay during the leave","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"a5886764-5e88-4635-ad95-515fb3bdee5e","order":27,"text":"I understand that the pay treatment to apply to this leave will be: [Pay treatment (auto)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"081ab814-4c25-4741-b5ec-675871a2e515","order":28,"text":"Where Statutory Parental Bereavement Pay (SPBP) applies, I understand it is payable to eligible employees with at least 26 weeks' continuous service who meet the minimum average earnings threshold, at the statutory weekly rate or 90% of average weekly earnings, whichever is the lower. If I do not qualify for statutory pay, I understand I remain entitled to take the leave, and I ask that any enhanced contractual pay set out in your policy be applied.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"compassionate leave","type":"remove","operator":"="}]},{"id":"a8213f0f-1c7b-453b-a2a2-89a006d2fc6e","order":29,"text":"I should be grateful if you would confirm whether the leave will be paid at full pay, at a reduced rate, or unpaid, by reference to my contract and your compassionate leave policy, so that there is no later misunderstanding about my pay for the period concerned.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"a11860fc-da9e-4b73-aeb5-4975a3b0e6c2","value":"statutory parental bereavement leave","type":"remove","operator":"="}]},{"id":"8853e354-ae6d-4f7a-9386-a55ebb7328ea","order":30,"text":"Notice and evidence","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"da4b8458-e374-498c-8820-ba5e940e3f1f","order":31,"text":"In relation to supporting evidence: [Evidence (auto)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"05928d5c-1a5f-4277-88e3-edb487604491","order":32,"text":"I confirm that, where evidence is requested, I am content to provide reasonable documentation (such as a death certificate, order of service, or a self-declaration) at an appropriate time. I would ask that any such request be proportionate and made sensitively given the circumstances.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"23c6163f-dd8d-4ff5-a4bb-df0e6bff9b9a","order":33,"text":"Handover and cover arrangements","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"4d38503d-c13c-4712-813f-7e6cce506fe9","order":34,"text":"So that my absence causes the least possible disruption, I propose the following handover arrangements during my leave: [Handover details].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"342c5ee3-0ac8-4ea8-8a6a-a972d3301992","value":"1","type":"add","operator":"="}]},{"id":"4c402dac-571c-47d6-a22a-a181b8462c57","order":35,"text":"My urgent work and ongoing matters can be referred in my absence to [Colleague(s) covering / point of contact], whom I will brief before my leave begins so far as I am able.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"342c5ee3-0ac8-4ea8-8a6a-a972d3301992","value":"1","type":"add","operator":"="}]},{"id":"512fae03-0231-42c4-9d76-35319fabebad","order":36,"text":"I would be grateful if internal and external contacts could be informed only to the extent necessary, and that the reason for my absence be kept confidential beyond those who need to know.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"3781080c-9e84-4f47-9bed-50a74d4a1e0d","order":37,"text":"Keeping in touch and return to work","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"d2000eb6-a15b-4eb7-9a92-3edd7b835648","order":38,"text":"During my leave I would prefer that contact be kept to a minimum and limited to essential matters only. I am happy to be reached, where genuinely necessary, by the following means: [Preferred contact method during leave].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"d65deaf7-3590-44d1-a572-d94484f8a175","value":"1","type":"add","operator":"="}]},{"id":"83694b02-ac0c-4a29-b292-3180ce0ea0f7","order":39,"text":"I would prefer not to be contacted during my leave save in a genuine emergency, and ask that routine matters be held over until my return.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true,"displayConditions":[{"field":"d65deaf7-3590-44d1-a572-d94484f8a175","value":"1","type":"remove","operator":"="}]},{"id":"0f679327-9998-492f-b72b-fa91e9bcc277","order":40,"text":"I anticipate returning to work as set out above, and would welcome a brief, supportive return-to-work conversation to agree any reasonable adjustments to my workload on my return. I understand that I may request to vary or cancel booked leave by giving you appropriate notice in writing, and that any leave cancelled may be re-taken within the applicable statutory window.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"3fefb035-8736-431f-8c76-d722bf9ceaf3","order":41,"text":"Confidentiality and data protection","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"53e00180-dd84-4f24-a90c-9b44c38e4d06","order":42,"text":"The information in this letter includes personal data, and may include special category data concerning health or family circumstances. I provide it for the sole purpose of administering my leave and pay. I ask that it be processed in accordance with the UK General Data Protection Regulation and the Data Protection Act 2018, retained no longer than necessary, and disclosed only to those with a legitimate need to know.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"ee4dd656-9e4b-4401-833d-f38a04431da9","order":43,"text":"Confirmation requested","fontSize":"16","textAlign":"left","bold":true,"underline":true,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10"},{"id":"ca1d7450-7308-47e6-8567-b773d61c8154","order":44,"text":"To avoid any later dispute about what was agreed, I should be grateful if you would complete and return the written confirmation at the end of this document, confirming the approved dates, the pay treatment and any conditions. Please send your written confirmation to [Your work email (for confirmation)]. I am, of course, happy to discuss any of the above with you.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"fca68a9d-eb13-4486-8b70-6954a2e3c0a1","order":45,"text":"Thank you for your understanding and support at a very difficult time.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"7c863134-a2f8-46ab-8169-637915409479","order":46,"text":"Yours sincerely,","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"f4c5a043-0e57-4101-8d30-21875ccfd9eb","order":47,"text":"[Your full name (signature)]","fontSize":"14","textAlign":"left","bold":true,"underline":false,"marginBottom":"0","cflou":false,"active":true},{"id":"5f2dc105-68fa-430a-ba75-b4ef4883cb7b","order":48,"text":"[Your job title (signature)]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"30","cflou":false,"active":true},{"id":"bd813f12-7382-4082-8624-150ead6a33d5","order":49,"text":"EMPLOYER CONFIRMATION OF APPROVED LEAVE","fontSize":"16","textAlign":"center","bold":true,"underline":true,"marginBottom":"15","cflou":false,"active":true,"marginTop":"20"},{"id":"e78fb7bd-818b-4391-a289-261d210252ff","order":50,"text":"This part is to be completed by the employer and returned to the employee. It records the leave as approved, for the purposes of payroll, handover and planning.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"15","cflou":false,"active":true},{"id":"fcb31ee4-d537-4bba-aca8-767216397d9e","order":51,"text":"Employee: [Employee full name (confirmation)] — Employee / payroll number: [Employee / payroll number (confirmation)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"ccb2b243-a1cd-4f05-b36d-1c16d4708d83","order":52,"text":"The leave described above is approved as [Leave type (confirmation, auto)], taken as [Pattern (confirmation, auto)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"95248983-272c-49ac-b939-b62b998c0f72","order":53,"text":"Approved start date: [Approved start date]. Approved end date / expected return: [Approved end date / expected return].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"a6be0e5f-46dd-40ff-a8ca-523925ee4994","order":54,"text":"Pay treatment confirmed: [Pay treatment confirmed]. Payroll has been (or will be) instructed accordingly with effect from the start date above.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"1185dc6e-7347-4c6e-9567-93cf767e43f9","order":55,"text":"Conditions or notes (if any): [Conditions / notes].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"d4738ee5-8144-4fc6-b611-c3fbd5711490","order":56,"text":"Confirmed on behalf of the employer by [Name of person confirming], [Role of person confirming], on [Date of confirmation].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"ee141d05-3e78-4433-a14e-5f884e18ac9e","order":57,"text":"Signed (employer): ____________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"bf51f30a-8b83-484a-9956-09c9ed7d6a38","order":58,"text":"Signed (employee, acknowledging receipt): ____________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true}]