V5 GLOBAL SERVICES PRIVATE LIMITED

D-13/5 Okhla Phase-2 New Delhi- 110020

Telephone No.:011-40655600, Fax No. 011-26232329 Website: www.v5global.com

Full & Final Settlement Form

Name of the Employee:____________________________________________

Designation: ____________________________Location: _________________

Project: ____________________________Date of Joining: _______________

Emp. ID: __________________ Date of resignation: ____________________

Notice period served:_____ days. Date of leaving:__________________

Reason for Leaving: (Please Tick) a)Counter/ Store Issue b) Location issue
c) Salary/Incentive issue d) RPM/TL/AM issue e) Better opportunity

Submission of Laptop (If any): ______________

Submission of ID Card:_________________

Submission of Demo Unit:________________

Payment Entitlement:

My full and final settlement amount of Rs. ………………../- of Salary/ Incentives/ Claims
for the month of __________ is pending/ due against V5 Global Services Pvt. Ltd. & I
hereby declare to please transfer my amount in the account number
_________________ maintained in Kotak Bank OR dispatch my cheque to below
mentioned address:

Address:

Employee’s Signature: ____________________

Date: ____________________

Note: Duly signed letter to be sent back to below mentioned address:

Kind attention: Name of Respective HR

V5 Global Services Pvt. Ltd.
D-13/5
Okhla Phase-2
New Delhi- 110020
(Scanned copy is also acceptable)