ENERGY MANAGEMENT SERVICES SDN

INTERNAL CLEARANCE FORM

(FOR FOLLOW UP BY RESPECTIVE DEPARTME

EMPLOYEE NAME

EMPLOYEE NO

DEPARTMENT

LAST DAY OF SERVICE

NO

ITEM

CLEARANCE CONFIRMED
BY

Staff Employment Pass

Human Capital

Staff & Dependent Medical Card

Human Capital

Staff Account

Company's Car

Rental arrears, keys, electricity/water &

telephone bills

Admin

Office Access Card

Admin

Car Park Access Card

Admin

Petrol Fleet Card

Admin

'Smart Tag' device

Admin

Finance
CEO/HOD

10 Handphone

Admin

11 Locker Keys

Admin

12 Laptop/Notebook
13 Files/Document

IT
Head Of Div/Dept

Employee's Signature: .

Signature: ....
CEO/Head Of Div/Dept

Signature: .....
Admin Department

Signature: .....
IT Department

Signature: .....
Human Capital Department

GEMENT SERVICES SDN BHD

L CLEARANCE FORM

BY RESPECTIVE DEPARTMENTS)

AUTHORISED

SIGNATURE
& NAME

DATE
RECEIVED

REMARKS

Date:

Date:

Date:

Date:

Date: