CLEARANCE CHECKLIST – FORM A

Employee Number Date Hired

75005791 October 2, 2017
Employee Name Date of Last Working Day
Jayson Delos Reyes October 15, 2021
Immediate Manager Business Unit
Marie Joyce Mendoza Workplace and Mobility
Personal Email Address Place of Birth
jaysondreyes@gmail.com Cabanatuan City, Nueva Ecija
Current Home Address
Unit-K, 49 Pangasinan St., Brgy. Sto. Cristo, Bago Bantay, Quezon City, 1105
Permanent Home Address
15 Magsaysay St., Calaocan District, Rizal, Nueva Ecija, 3127
INSTRUCTIONS:
1. All employees leaving DXC Technology must completely accomplish this form, by ensuring all boxes are appropriately
checked and have corresponding valid signatures.
*Note: If item is not applicable to you, check “N/A” box and have your manager of function SPOC sign off. Ensure all boxes
under the last column are signed.
2. Please DO NOT FORGET to attach copy of your Government ID as part of the mandatory requirement.
3. After completing the form, SCAN and save in PDF format together with duly signed copies of your Resignation letter, Non-
Disclosure Agreement (downloadable from the DXC portal – Leaving DXC Philippines Employee Checklist page), online Exit
Survey confirmation email, and copies of emailed approval (i.e. from Payroll) as applicable.
4. Go to External HRConnect link https://dxchr.service-now.com/csp to register and submit your request. Attach all scanned
copies in PDF format. No need to physically submit documents to HRSS.
5. Acknowledgment or status update will be provided whether your submitted documents are complete or incomplete within
three (3) business days upon assignment of case.
6. For complete status, expect release of your Certificate of Employment within 5 business days.

Function / SPOC Clearance Items for To Do’s Cleared by In- Signature over
with Location and Checking by In- charge? printed name
Schedule Charge (Yes / if No, state of In-Charge /
reason) Date
1. Business Unit • Resignation letter (if Employee to obtain copy of  Y
Manager or Immediate applicable) signed by resignation letter signed by  N
Manager employee and Manager  N/A
accepted by
Manager
• Exit / Termination a. For Voluntary resignation  Done by
on Workday c/o (Resignation with Notice) - manager on-
Manager Workday termination must be time
done not later than 5 days  Done late
prior effectivity of employee’s (indicate date):
resignation. Recommended
time for termination is within 5
business days post acceptance
of resignation letter.
b. For Immediate resignation or
Note: No need for Termination for Cause –
employee to surrender Termination must be done
HMO card within 24 hours of effectivity.

This document may be reviewed from time-to-time to reflect changes in accordance to DXC Technology’s business requirements. Management reserves
the right to alter, add, or delete information in this document as it deems appropriate and in accordance with applicable laws. Revised April 2018.
Clearance Checklist – Form A
 Manager must do above action to
trigger cancellation of Amex card
(if applicable) and HMO account.

• Completion of the Manager must instruct the employee  Y

online Exit Survey (go to complete survey before the  N_______
to Leaving DXC effective date of the resignation. (if employee was
Philippines portal)
terminated in the system,
Employee must complete the survey,
manager must do exit
print the confirmation page and
attach it to the clearance form interview to comply with
this requirement

(Con’t.) Business Unit • Surrender of Amex Employee to CUT and  Y

Manager or Immediate card for cancellation SURRENDER Amex card to  N
Manager (if applicable) manager no later than 1 week prior  N/A
effectivity of resignation.

ACTION: Employee to send AMEX

Card cancellation request To:
paul.debelen@dxc.com – Provide
complete name, employee ID, and
corporate card number. And
request for cancellation confirmation
and zero balance to be attached to
exit clearance form.

Manager to receive and immediately

discard the card.

• Accountability for Employee to ensure zero  Y

AMEX credit card (if accountabilities, or settle any  N
applicable) pending payments prior to  N/A
effectivity of resignation.
Amex accountability:

Php_____________
• Accountability for Manager to check if employee is
bonuses under a bonus/retention program,
(tick applicable type): and if any amount needs to be
recovered.
If with accountability, Manager to  Y
 Sign-on inform HRSS/Payroll via  N
External HRConnect amount to Accountability:
be charged/credited to employee Php:_____________
before payroll cut-off date.
 N/A
Email subject:
“Attention: Accountability of
Resignee <Employee Name>”
 Retention / Hot  Y
Skills  N
Accountability:
Php:_____________
 N/A

 Language  Y
Allowance  N
Accountability:
Php:_____________
 N/A

This document may be reviewed from time-to-time to reflect changes in accordance to DXC Technology’s business requirements. Management reserves
the right to alter, add, or delete information in this document as it deems appropriate and in accordance with applicable laws. Revised April 2018.
Clearance Checklist – Form A
  Others (please  Y
specify)  N
Accountability:
Php:_____________
 N/A

• Turnover of files/ Employee to turnover items  Y

records/ working to Manager  N
papers  N/A
• Client data systems/ Employee to turnover items  Y
access, customer to Manager  N
access key/badge  N/A
• Exit interview c/o BU or Manager to coordinate exit interview  Y
Immediate Manager  N
 N/A
*For AS: Use BSPC
Attrition Tool
• Visa Cancellation Manager to email cancellation  Y
request - for foreign request to Dexter Evangelio -  N
national employees <DEvangelio@Fragomen.com>  N/A
with HP-sponsored
visa Employee to attach Manager’s
email request to this Clearance
Checklist.
• Retention Bonus Manager to check and confirm if  Y
employee has Retention Bonus  N
 N/A

2. Information • Laptop / Desktop / Employee to turnover items to IT  Y

Technology (IT) charger  N
For accountabilities, IT to inform Accountability:
HRSS/Payroll via External Php:_____________
HRConnect amount to be
charged to employee before
 N/A
payroll cut-off date. Email
subject: “Attention:
Accountability of Resignee
<Employee Name>”

3. Asset Logistics Team • Approved Asset Employee to have the form  Y

Acknowledgement signed by Asset Logistics Team  N
Proceed to 3/F IPC Form Accountability:
Building • Indicate accountability Php:_____________
(if any)  N/A

4. Business Operations c/o • Employee assigned Employee to complete exit  Y

Asset Champions:
AS / ITO – c/o Business
Center at 3F IPC or 5F
ETON
BPS – c/o immediate
manager
assets and
accessories
• Other company-issued
items such as Mobile
Phone, headsets, and
broadband device
interview and turnover assets  N
to Asset Logistics Team or  N/A
follow applicable process per
BU.

This document may be reviewed from time-to-time to reflect changes in accordance to DXC Technology’s business requirements. Management reserves
the right to alter, add, or delete information in this document as it deems appropriate and in accordance with applicable laws. Revised April 2018.
Clearance Checklist – Form A
 5. CSS (Corporate
Security Services)

IPC - 4F, IPC, Mon-Fri,
9am-5pm

Eton - 12F, Eton,
Mon-Fri, 9am-5pm
6. REF (Real Estate
Facilities)
IPC - 11F, IPC, Mon-
Fri, 9am-5pm
Eton - 12F, Eton,
Mon-Fri, 9am-5pm
7. Warehouse – for
Enterprise Group GSD
employees only
Not Applicable for non-
Enterprise Group GSD
employees
8. Finance – for Sales
employees only
Not Applicable for non-Sales
employees
 Finance Analyst for ES –
Bernadette Gomez
bernadette.lazatin-
gomez@dxc.com
9. Learning & Development
 Employee to secure email
clearance from L&D mailbox at
tpaasia@csc.com
10. Payroll
 Employee to secure email
clearance from PHL Payroll
team at es-phl-
payrollclearance@dxc.com
This document may be reviewed from time-to-time to reflect changes in accordance to DXC Technology’s business requirements. Management reserves
the right to alter, add, or delete information in this document as it deems appropriate and in accordance with applicable laws. Revised April 2018.
Clearance Checklist – Form A
• Proximity card / ID Employee to turnover items  Y
Badge to Security Office on site.  N
For accountabilities, CSS to  N/A
inform HRSS/Payroll via
External HRConnect amount to
be charged/credited to employee
before every 20th of every
month. Email subject: “Attention:
Accountability of Resignee
<Employee Name>”
• Locker key/ Book key Employee to turnover items  Y
to GRE Office on site.  N
Note: Employee with  N/A
locker key must indicate For accountabilities, REF to
locker number. inform HRSS/Payroll via
External HRConnect amount to
be charged/credited to employee
before payroll cut-off. Email
subject: “Attention:
Accountability of Resignee
<Employee Name>”
• Parts accountability Employee to turnover part/s (if any).  Y
For accountabilities, Warehouse  N
SPOC to inform HRSS/Payroll via  N/A
External HRConnect amount to be
charged/credited to employee
before payroll cut-off. Email
subject: “Attention: Accountability
of Resignee
<Employee Name>”
• Sales commission • Finance Analyst to confirm via email if  Y
employee has pending commission.  N
• If amount is not yet available, FA to  N/A
indicate “Pending commission”.
• Training and • L&D to check if employee  Y
Agreement has an existing training  N
Program under bond.  N/A
Talent
Management
• Tool of Trade Payroll to check remaining  Y
allowance balance  N
(if applicable) • If TOT via Citibank - inform Citi of  N/A
resigned employee and include
balance (if any) in final pay
• If Tool of Trade via Payroll –
include balance (if any) in final pay
 • Calamity Loan Payroll to check if employee has  Y
(if applicable) outstanding balance and indicate  N
amount if any Accountability:
Php:__________
 N/A

• Cash Advance/ Payroll to check if employee has  Y

Other payables to outstanding cash advances and  N
the company indicate amount if any Accountability:
Php:__________
 N/A

• Retention Bonus Payroll to check and provide  Y

Retention amount for claw back  N
Accountability:
Php:__________
 N/A

• HMO Premium Tax Payroll to check and provide HMO  Y

Clawback Premium Tax Clawback  N
Accountability:
Php:__________
 N/A

For HRSS use only:

HRSS • Check if female If none, proceed with clearance.  Y
External HRConnect employee has If yes, HRSS to HOLD clearance until  N
https://dxchr.service- pending MAT2 Employee submits MAT2 requirements  N/A
now.com/csp requirements
• Clearance checklist HRSS to double check completeness of  Complete
this clearance form.  Incomplete

I understand that should I have any accountabilities to Enterprise Service (AP) Limited Philippine Regional Operating Headquarters
(ESAP) / Entserv Philippines, Inc., it is my responsibility to settle my obligations to the company. Furthermore, I authorize the
company to deduct the amount due from any or all of the following components of my final pay in accordance with applicable laws:
encashable leaves, retirement benefit, flexible benefit credits, and variable bonus, regardless of whether my separation was
voluntary or not. Should I be unable to settle my outstanding obligations, I understand the company may take corresponding actions
as legally permissible.

______________________________________
Employee’s Signature over Printed Name / Date
Next Steps:
1. Double-check your compliance to instructions on page 1 before submitting this form.
2. After submission, wait for notification on your Final Pay computation to be sent by payroll vendor.
3. For those eligible to Retirement, Retirement benefit will be paid via your ATM payroll account sixty (60) business days after final pay has been credited to your payroll
account, subject to Payroll’s cut-off date.

This document may be reviewed from time-to-time to reflect changes in accordance to DXC Technology’s business requirements. Management reserves
the right to alter, add, or delete information in this document as it deems appropriate and in accordance with applicable laws. Revised April 2018.
Clearance Checklist – Form A
This document may be reviewed from time-to-time to reflect changes in accordance to DXC Technology’s business requirements. Management reserves
the right to alter, add, or delete information in this document as it deems appropriate and in accordance with applicable laws. Revised April 2018.
Clearance Checklist – Form A