Clearance Form

NAME : GEORGE P S

DESIGNATION : SALES AND MARKETING EXECUTIVE

STAFF NO. & DEPT. : HC 1741, MARKETING

DATE OF JOINING : 01/04/2019

LAST WORKING DAY : 11/12/2020

BUSINESS UNIT : MARKETING

We, the undersigned have received the following documents/details from the above mentioned employee, as per
the remarks stated below:-

01 - EMPLOYEE'S DEPARTMENT

Received /Not
DETAILS Authority
received

Handover of responsibilities: Name: LAL M R

Periodicals

Manuals

Licenses:

Books Designation: Department Head

Office equipment’s/Keys: Signature:

Others: Date: 11.12.2020

REMARKS: Directed to HR

02 - HR ADMIN

Received /Not
DETAILS Authority
received

✔ Company ID Card: Name: JOHNSON JAMES

✔ Mobile-Handset Designation:

✔ Sim card

Others: Business cards Signature:

Clearance Form Health Careers Group

HCG/HR/GEN/05 Ver 01 Dt: 24.10.2017 Rev 02 Dt: 01.07.2020 www.healthcareersgroup.in
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 Clearance Form

REMARKS:
Date:

03 - INFORMATION TECHNOLOGY

Received /Not
received /
DETAILS Authority
Completed
/Pending

Removal of user
name/Passwords/login credentials Name: ANOOP
/email:

PC Designation:

✔ Laptop

Pen Drive

Dongle

Headset

Mouse

Printer

Webcam

Others: Signature:

REMARKS: Date:

04 - FINANCE

Completed
DETAILS Details of person who collected the same
/Pending

Advance Payments: Name:

Staff Ledger Recovery: Designation:

*Retention Money Signature:

Others: Date:

Clearance Form Health Careers Group

HCG/HR/GEN/05 Ver 01 Dt: 24.10.2017 Rev 02 Dt: 01.07.2020 www.healthcareersgroup.in
Page 2 of 3
 Clearance Form

REMARKS:

05 - To be completed by Staff

I, the undersigned, authorize the Company to retain an amount against uncleared bills/dues and deduct
any outstanding amount from my 'Full & Final Settlement' / Retention money and return the balance to my
Salary bank account.

Contact No:

9544115335

Bank A/C No:

626701522377

Bank Address:

ICICI BANK, COLLECTORATE BANK, KOTTAYAM, IFSC- ICIC0006267

Employee Signature: Date: 11/12/2020

Name: GEORGE P S

Human Resources dept.:

Designation:

Signature:

Date:

Clearance Form Health Careers Group

HCG/HR/GEN/05 Ver 01 Dt: 24.10.2017 Rev 02 Dt: 01.07.2020 www.healthcareersgroup.in
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