NO DUES FORM

EMPLOYEE CODE: EMPLOYEE NAME:

LOCATION : DEPARTMENT:

DATE OF JOINING: DATE OF RESIGNATION :

LAST WORKING DATE:

REPORTING OFFICER: HOD’S SIGNATURE:

List of Documents/ Assets to handover

INVENTORY DEPARTMENT:

Documents/Assets (Please Surrendered / Authorized Signature’s :

S.No.
write the Articles name ) Deactivated Signatory Store Head

FINANCE

S. No. Documents/Assets Surrendered / Authorized Signature’s :

Deactivated Signatory Finance Head

1 Any Imprest

2 Travel Advance

3 Outstanding Loans / Advances

4 Any other (Please Specify)

5
 INFORMATION SYSTEM :

S. No. Documents/Assets Surrendered / Authorized Signature’s :

Deactivated Signatory IS Head

1 Desktop password Disabled

2 Laptop Returned

3 PEN /USB Drive

4 E-Mail id password Disabled

5 Any other (Please Specify)

HUMAN RESOURCE

S. No. Documents/Assets Surrendered / Authorized Signature’s :

Deactivated Signatory Human
Resource
1 Notice pay Recovery Head

2 Leave Balance

3 Drawer Key

5 ID Card, Visiting Card

Address for Communication (for all future correspondence i.e. Full & Final Cheques, Reliving letter etc.)

Contact Number ___________________________________________

Declaration

I hereby agree and acknowledge that all Intellectual Property (including but not limited to
copyrights, designs, trademarks, patents, logos) whatsoever in my possession or created by me
for SPARRC INSTITUTE during the course of my employment with SPARRC INSTITUTE are
exclusive property of SPARRC INSTITUTE and I shall not, at any time, assert or claim any right
or interest thereto. I also agree that if proof of investment is not given at the time of final
settlement of dues, the entire income will be taken as taxable.

(Signature of the Employee) Date