[Type text] [Type text] [Type text]

Exit Clearance form

An Employee is required to return the Company’s properties to the respective Department before leaving the service of the Company.
He/She is instructed to bring this form to the various Departments as stated below to obtain Clearance before collection of Relieving
Letter. This form should be completed between the hours of 10:00 a.m. to 6:00 p.m. Monday through Friday or before your last working
day.

Employee’s Name: ___________________________ Department: _______________

Last Working Day: ___________________________ Location: __________________

Operation:
Date Department Clearance Comments Signature
Cleared
Reporting Handover (project)
Head (TL)

Admin Keys
Admin ID Card
Admin Access Card
Admin Cellular phones
Admin Library Material
Admin Company Credit Card NA

Finance Advances Returned

Finance Balance Dues

IT E-mail Id deactivated
IT Laptop & Accessories

I certify that to the best of knowledge, all appropriate areas have been properly cleared. I understand that COMPANY NAME reserves
the right to request the restitution of or payment of any property or the settlement of any outstanding obligations that might have been
excluded from this clearance process.

Employee’s Signature: Date: _____________________

Human Resources: Date: ______________________

[Type text] [Type text] [Type text]