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Form for employee to provide notice and evidence of entitlement to parental bereavement pay

Original author: Stephen Simpson

When to use this model parental bereavement pay form

Use this model HR form to allow an employee to provide notice and evidence of entitlement to statutory parental bereavement pay.

This example form is designed to be sent together with a letter to an employee confirming that they are taking parental bereavement leave, so that the employer can highlight the support that they are providing to the employee while also discreetly gathering the information required to pay statutory parental bereavement pay.

Note: The usual rules for calculating normal weekly pay for the purpose of determining entitlement to, and the rate of, statutory parental bereavement pay are adjusted for employees who are furloughed under the Coronavirus Job Retention Scheme. See Family-related statutory payments and furlough leave in Coronavirus Job Retention Scheme.