DOCUMENTS CHECKLIST FOR FULL AND FINAL

(FOR OFFICE USE ONLY)

S.No. CHECK POINTS DOCUMENTS ATTACHED

EMPLOYEE DETAILS & CLAIM FORM (DULY SIGNED
1 YES [ ] NO [ ] N.A. [ ]
BY EMPLOYEE)

2 FULL & FINAL RECEIPT (DULY SIGNED BY EMPLOYEE) YES [ ] NO [ ] N.A. [ ]

ORIGINAL AFFIDAVIT
3 (TO BE MADE ON RS.20/- STAMP PAPER AND MUST YES [ ] NO [ ] N.A. [ ]
BE ATTESTED BY NOTARY)

RECOMMENDATION LETTER BY PROJECT MANAGER

4 YES [ ] NO [ ] N.A. [ ]
FOR RELEASING DUES
RECOMMENDATION LETTER BY PROJECT MANAGER
5 YES [ ] NO [ ] N.A. [ ]
FOR EXPERIENCE LETTER
RESIGNATION LETTER (DULY SIGNED BY EMPLOYEE &
6 YES [ ] NO [ ] N.A. [ ]
PROJECT MANAGER)
NO DUE CERTIFICATE ISSUED BY THE OFFICER
7 INCHARGE / PRINCIPAL EMPLOYER OF THE YES [ ] NO [ ] N.A. [ ]
EMPLOYEE
CLEARANCE FORM SIGNED BY ALL DEPARTMENT
8 HEAD YES [ ] NO [ ] N.A. [ ]
(APPLICABLE FOR HO EMPLOYEES ONLY)
9 ID CARD ISSUED BY COMPANY YES [ ] NO [ ] N.A. [ ]
SUPPORTING DOCUMENT FOR BANK ACCOUNT
DETAILS AS MENTIONED IN FNF DOCUMENTS (e.g.
10 YES [ ] NO [ ] N.A. [ ]
BANK PASSBOOK/ CANCELLED CHEQUE/ BANK
ACCOUNT STATEMENT)

Project Manager’s Name & Signature : ______________________________________

HR Name & Signature : ______________________________________

1
 EMPLOYEE DETAILS & CLAIM FORM
(TO BE FILLED BY EMPLOYEE)

Name
Father’s / Husband’s name
Employee Code
Designation
Project/ Location
Date of birth
Date of joining
Date of leaving
Reason of leaving
EPF/ UAN Number

Full postal address

Mobile number
Email ID
Bank name
Bank A/c number
IFSC Code

Branch Address

DETAILS OF CLAIMED DUES :

Salary
Over time
Security
Any addition
Any deductions
Net payable

________________________
Employee Signature

2
 FULL AND FINAL RECEIPT
(TO BE FILLED BY EMPLOYEE)

I, ____________________________ S/o D/o W/o ___________________________

resident of ____________________________________ bearing Employee ID
______________ worked in _______________ (project) at ______________
(location) certifies that I have received a sum of Rs. ________________ Rs.
___________________________ only (in words) in cash/ cheque/ DD/ RTGS vide number
__________________ dated ______________ as full & final settlement of my claims
including security/ salary/ travel reimbursements for work done in the above stated
project towards the company i.e. M/s Xeam Ventures Pvt Ltd, E-202, Phase-8B, Indl.
Area, Mohali-160055. I hereby declare that I have no claims pending with the company
on any account till date of signing this form.

Signature : __________________________________

Name : __________________________________

Employee code : __________________________________

Project/ Location : __________________________________

Date : __________________________________

3
 (TO BE PROVIDED BY EMPLOYEE ON RS.20/- STAMP PAPER AND MUST BE ATTESTED BY NOTARY)

AFFIDAVIT

I, _____________________________________ S/o D/o W/o _________________________________

R/o ________________________________________________________________ had resigned from
my contractual job as a ________________ (designation) deployed at ______________ (project)
____________ (location) do hereby solemnly affirm and declare that:

1. I have resigned from my contractual job due to my personal reasons.

2. I have received my all pending dues including security deposit, salary, arrears, allowances,
overtime, TA or any other allowance/ amount. I have also settled my bonus and gratuity with
XEAM Ventures Pvt. Ltd, Mohali and nothing is pending on any account from the company
(M/s Xeam Ventures Pvt Ltd, Mohali) till date.

3. I have received my PF number & ESI number from the company (as per applicability).

4. I have settled my all accounts and issues with the company. I will not approach any third
party, arbitrator, any government authority or court for the same in future ever.

DEPONENT

VERIFICATION

I, the above name deponent hereby verify that the contents of my this affidavit are correct and
true to my knowledge and nothing has been concealed herein and no part of it is false.

DEPONENT

DATE:
PLACE:

4
 RECOMMENDATION LETTER
FOR RELEASE OF DUES
(TO BE FILLED BY PROJECT MANAGER)

Name : __________________________________________________
Employee Code : __________________________________________________
Designation : __________________________________________________
Project & Location : __________________________________________________
DOL : __________________________________________________
Reason for leaving : __________________________________________________
Resigned : YES/ NO
Notice period served : YES/ NO
Remarks : __________________________________________________
Discontinued : YES/ NO
Reason for discontinuation: __________________________________________________
_________________________________________________________________________
Detail of pending dues : __________________________________________________
Security : __________________________________________________
Salary : __________________________________________________
Deduction (if any) : _________________________________________ ________
Net payable recommended: __________________________________________________
*Final Recommendation by Project Manager:
_________________________________________________________________________
_________________________________________________________________________
Signature with date : _________________________________________ _________
Project Manager’s name : __________________________________________________

5
 RECOMMENDATION LETTER
FOR EXPERIENCE CERTIFICATE
(TO BE FILLED BY PROJECT MANAGER)

Dear HR,

Mr./ Ms. ……………………………………..………….…………… S/o D/o W/o……………………………………………………………… has

made a request to issue him/ her an experience certificate (request letter and other documents are
attached) so that he/she may apply for betterment of his/her future life.

I have checked his/ her record with my true spirit from my all sources and found that:

His/ Her name as per our record is : ______________________________________________

His/ Her Father’s/ Husband’s Name is : ______________________________________________

His/ Her period of working is/was : From _________________ To _____________________

He/ She worked for our Project & Location : ______________________________________________

His/ Her designation is /was : ______________________________________________

His/ Her employee code is /was : ______________________________________________

His / Her behavior is/was : ______________________________________________

He/ She was defaulter (Y/N) : ______________________________________________

His/ Her documents are attached (Y/N) : ______________________________________________

Thus, I STRONGLY RECOMMEND / NOT RECOMMEND issuing him/ her an experience certificate.

Date: ________________ ____________________________

Project Manager’s Signature

_____________________
Approving Authority