Employee Clearance Form – Resignation

Name:
Designation:
Dept:
Joining Date:
Resignation Date:
Relieving Date:
The following authorities of each department shall make sure and sign
that employee has already returned everything that belongs to each
department.
Department / Office Employee Authority
IT Department
Assets - S/W, H/W
Login Id / E-mail ID
Access card
Laptop/Internet Access
Any other Company Assets Signature: Signature:
CUG No. Date: Date:
Administration Dept
Identity-cum-Attendance Card
Card Holder /Drawer Keys/ Transport dues
Cell phone
Lunch dues Signature: Signature:
Books Date: Date:
Finance Dept Signature:
Confirmation of full & final settlement / Corporate Card [Y/N] / If Date:
Yes, Clearance
Loans/Advance Signature:
Travel advance Date:
HR Dept Signature:
CLEARANCE FROM HR (to be given only after obtaining all the Date:
above clearances and completion of exit interview) Signature:
Date:
Address for further Correspondence:
Signature of HR_______________________ Date ______________