Q U A L I T Y

R E C O R D S / F O R M S

EXIT CLEARANCE FORM

Doc. Level:IV Doc. No: CCPL-HR-F.12

Doc. Version: I w.e.f: 6th Feb. 2012

Name of the Employee Designation Date of Joining Date of Submission of Resignation Bank A/c No. Employee Address Contact Nos. (Resi.) Personal E-mail ID:

Employee Code Dept. Location Last Day

Mobile No.
PROBATION TRAINEE

Emp. Status(Pls tick whichever applicable) : PERMANENT

NOTE: 1. wherever there is no amount payable pl. mention NIL and sign. 2. If a particular point is not applicable pl. mention NA and sign.

1. Instructions to IT Sr. LOGIN ID to be disabled from: 1 MAIL ID to be disabled from: 2

Sign. (Immediate Supervisor) Date:

Particulars

Sign. (IT Authorized Signatory) Date:

2. To be filled in by Accounts/ Finance:

Particulars of Payment / Recovery on Account of 1. Advances 2. Telephone Expense 3. Personal Loan 4. Any Other Recovery/Payment Total(Rs.) Name: Amount Payable(Rs.) Amount Recoverable(Rs.)

Signature:

Date:

3. To be filled in by HR:
Particulars 1. Notice Pay Payable/Recoverable 2. Encashment of PL (Working Days) __________ No. of Days 3. Relocation Expenses(In case of Outstation Employees) __________ Amount 4.Income Tax Proofs( Whether attached for Tax Exemption Purpose)(Yes/No/NA) 5. Is Exit interview form attached (For information of HR)-(Yes/No) 6. Is Resignation Letter Attached? (Yes/No) Name: Signature: _______No. Of Days ______ Amount Payable __________No. Of Days Recoverable _______No. Of Days

Date:

4. To be filled in by Administration:
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Q U A L I T Y

R E C O R D S / F O R M S

EXIT CLEARANCE FORM

Doc. Level:IV Doc. No: CCPL-HR-F.12

Doc. Version: I w.e.f: 6th Feb. 2012

Companys Property returned / recovered. Specify Yes / No. If not applicable mention N.A. Pl. mentions the amount Recoverable, if any.
Particulars 1. Identity Card 2. Laptop with all accessories 3. Office / Desk keys 4. Company Mobile 5. Calculators / Instruments 6. Business Cards 6. Company documents 7. Company book / Manuals 8. Promotional material etc 9. Briefcase / Travelling Kit 10. Any other Recovery Name: Yes / No / N.A. Date of Return

Signature:

Date:

______________________ Signature of Employee Date:

___________ Manager HR

___________ Date

ONTROLLEDONFIDENTIAL

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