Nokia Siemens Network

Full & Final Clearance Form

(for Resigned Employees & for employees moving-out on International Transfers)
Note: Please make sure that relevant columns have been signed and completed by relevant concerned person
Exiting employee details
Name of the employee NSN ID

Designation & Department Base Location

Date of Joining Job Grade

Date of Resignation Future Contact

Information
Last Working day at Work Personal
e-mail ID
Mailing Address:

Contact Number(Mobile) Number(Landline)

Dept Particulars Particulars Dept Particulars Remarks / Signature / date

Company lease vehicle Files, docs, manuals, designs,
HRC Benefit Admin

-Car Foreclosure Amount drawings, records, Handover

-CLV EMI stopped document
-CLV Insurance/Tax Recovery
Company owned/ leased Product samples,
Accommodation Equipment, Tool Kit etc.
-Security Deposit refund
-CLA stopped
SLM

- Advance rent adjustment

Credit Card no dues from bank Notification sent to Customer (if
required)
Insurance details captured for Notification to IT for disabling mail-
deletion including Id/Network Login/Access
Human Resource

Mediclaim/life/GPA permissions etc

USB Internet kit
Education assistance recovery Any other
(if any)
Recovery amount of joining Laptop/ Computer/
HRC Payroll

related benefits Peripherals

Country controlling

- Joining bonus
- Relocation lump sum
- prev employer notice pay
Notice Pay recovery amount Mobile handset
Balance Leave days Landline Telephone at home (if any)

Tax Investment proof submitted Power of Attorney

HRAC

Balance Incentive amount/ Access Card &

Security

Score
ID-Card

Account clearance, reimbursement

WME

balance etc
Parking Sticker Relocation Expenses
(Transportation etc)
SAS

Cabinet Keys Travel Advance /Salary Advance

Recoverable
Email ID Deactivation Hard Furnishing details (if
IT

applicable)
Remote Access Deactivation SIM Card
-Secure ID (Attach E-mail cancellation print
Please send the mail to below request from VMT tool)
VMT

mention e-mail id for

deactivation of E-mail ID
Nsnindia, Ithelpdesk (NSN -
IN);

Line Manager: HRAC

Employee Declaration
Nokia Siemens Network

I_______________________________holding the designation___________________ at Nokia Siemens

Network (hereinafter “Company”) hereby declare that I have duly submitted and returned to the Company all
the Confidential Information and Proprietary Information belonging to the Company and its Customers that
were made available to me by the Company in the course of discharge of my duties to the Company and its
Customers.

I further declare that I have duly handed over to the Company all property belonging and owned by the
Company or of its customers, including books, files, reports, sales literature, correspondence, notice(s) and
any other materials in any tangible form that were in my possession for the meaningful discharge of my
duties.

I agree and understand that if at any time any Confidential Information, Proprietary Information or any other
property of the Company or its customers is found in my possession and/or if such Confidential Information,
Proprietary Information or any other property of the Company or its customers is/ has been misused by me at
any point of time, then the Company can charge suitable damages, which will be decided at the discretion of
the Company after taking into consideration the nature and extent of the violation and the Company also
reserves the right to institute appropriate legal proceedings against me.

I also understand and confirm that all that is stated hereinabove are without prejudice to the rights of the
company to recover any dues owed by me or any other entitlement of damages and or indemnities under the
either the contract of employment or any other agreement executed by me pursuant thereto and the Company
also reserves the right to institute appropriate legal proceedings , including but not limited to criminal
proceedings, against me in case of any non compliance of any of the aforesaid documents executed by me.

I make this Declaration out of my free volition and to the best of my knowledge.

Signature of the Employee_____________________Dated ________________________

Name of Employee __________________________________________________________

NSN ID. _________________________________________________________

Place : __________________________________________________________________