No-Dues Form

(for Exiting employees)

Name:

Emp
Code:

Date Of
joining:

Designation:

Company:

Date of
Resignation:

Branch:

Location:

Date of
Relieving

Resignation
submitted:

Department

Online v

Notice period
Days:

Hard copy

Due status
Cleared/ Due / NA

Activity
Official Documents

Supervisor (or)
Branch Manager

Administration

Amount for
Recovery

Signature
Name & Emp id

Rs:

Full Notice period served?

Yes /

No

Recovery
days:-

Any other dues

Rs:

Cell Phone, SIM

Rs:

Draw Key

Rs:

Any other dues

Rs:

Tour Advances

Rs:

Any other dues

Rs:

Laptop

Rs:

Any other dues

Rs:

ID card

Rs:

Name:
Emp Id:

Name:
Emp Id:

Accounts
Name:
Emp Id:

Technology
Name:
Emp Id:

rd

Local HR

Library
(only for HOEmployees)

Leaves availed from 23 of last

month to till last working day

PLs

LOPs

Any other dues

Rs:

Books

Rs:

Any other dues

Rs:

Name:
Emp Id:

Name:
Emp Id:

I hereby declare that I have handed over all documents, assets & financial dues to company if I found anything to be
returned or payable by me, I shall return/ pay equalent amount by cheque/Cash in favour of Company.

Signature of Employee
Enclosure:
1. If the resignation not submitted online then hard copy of resignation letter has to be attached with supervisor
acceptance with relieving date.
2. No dues form should be handed over to your HR coordinator with all clearances on your last working day.