CLEARANCE FORM

Date _____________

Name of Employee :___________________________

Employee ID Number :___________________________

Project/Department :___________________________ Position/Title: ________________

Date Hired :___________________________ Date of Separation: ____________

Compensation Basic Pay :___________________________ Allowance: ___________________

____________________________________________________________________________________
This is to certify that ________________________an employee of this Project who was separated from
The service effective ___________________has been cleared by this of property and monetary
accountabilities.

DEPARTMENT /PROJECT CLEARING OFFICER REMARKS DATE

(Signature over Printed Name)

Project Manager :___________________ ________________ ________________

Project Supervisor :___________________ ________________ ________________

Project Assistant :___________________ ________________ ________________

Property Warehouse :___________________ ________________ ________________

Finance & Accounting Manager:____________________ ________________ _________________

Payroll Section Head :___________________ ________________ __________________

HR Department Manager :___________________ ________________ __________________

Final Pay Computation

1.Salary and wages for payroll period Ending
Php___________x________ _________________
2.Unpaid overtime (if any) _________________
3.Unpaid Allowances (if any) _________________
4.Others _________________
TOTAL _________________
ADD:
13TH Month Pay _________________
Tax Refund _________________
Gross Amount Due Employee _________________
Less (Accountabilities _________________
TOTAL AMOUNT DUE: PHP _________________

Prepared by: Checked & Review by: Approved by:

Payroll Assistant Payroll Section Head HR Dept. Head