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LIKAS SHIP AGENCY INC.

Revision Number : 01
Retention Period: 2 yrs.
Revision Date : 01/19/2017
Page Number : 1 of 2
EMPLOYMENT CLEARANCE FORM
C.6.3

Instructions: This clearance form is signed by the department on the employee’s last working day. It is responsibility of
the employee to obtain clearance from the areas listed below. Clearance through the Human Resources
Office should be the last clearance area. The employee’s final payroll check will not be released without the
Human resources Office having a completed clearance form. If you are currently on Direct Deposit, it will
be cancelled on your last pay period.
Name : Ernesto O. Casten Vessel : SL MAPLE
Rank : 2nd Engr. Date of Disembarkation : Nov.26,2020
Date Hired : Effective Date of Resignation:
6/28/2018
Permanent Forwarding Address :

Clearance Area Items Signatures


Deck Department Cash Advance :
Savings & Loan :

Accountabilities : MASTER
Signature over Printed Name
Engine Department Cash Advance :
Savings & Loan :
Accountabilities : CHIEF ENGINEER
Signature over Printed Name
Cash Advance :
Crewing Department Disembarkation Notice :
Accountabilities : RUSSELL C. SASULUYA
Signature over Printed Name
Crewing Department Cash Advance :
Savings & Loan :
Accountabilities : LOIDA T. TAMOY
Signature over Printed Name
I.T. Department Cash Advance :
Savings & Loan :
Accountabilities : JESSIE JOSEPH
Signature over Printed Name
Accounting Cash Advance :
Department Savings & Loan :
Accountabilities :
Comp. ID :
SB – ATM : GENESIS M. TIMBAS
Maxicare : Signature over Printed Name

Contact No. :
Employee Name &Signature
(For HR use only) Inclusive Dates No. of Mo./Yr.
Separation Pay
13th Month Pay
VL / SL
Overtime/NSD

P.P.E. .
LIKAS SHIP AGENCY INC. Revision Number : 01
Retention Period: 2 yrs.
Revision Date : 01/19/2017
Page Number : 2 of 2
EMPLOYMENT CLEARANCE FORM
C.6.3

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