Employee

Departure
Clearance Form
Security Officer to complete: Date:
Name: Position:
Start Date: Department:

Last Day: Company ID No:

Email: Contact No. :

Returned Cost
Department Details Name/Signature
 
Uniforms
Shoes - (If Applicable)
Blanket - (If Applicable)
Housing Bedsheet & Pillow - (If Applicable)
& Security Uniform Belt - (If Applicable)
Admin / HR Visibility Jacket (If Applicable)
Winter Jacket (If Applicable)
Bull Cap / Sun Hat - (If Applicable)

Mobile Phone - (If Applicable)

Sim card - (If Applicable)
Laptop/Other Equipment - (If Applicable)
Others (Personal Protective Devices),
Operations Documents - (If Applicable)
Any other Damages Caused

Electronic Access - (If Applicable)

Any pending investigations

Other :
To be completed by Admin: Comments/Action (Any
To be completed by Accounts (loans/deductions, etc.)
disciplinary violations/Pending Issue)

Reason of Clearance/Departure from

company: (To be completed by HR)

Approvals & Acknowledgements:

Accounts Admin Human Resource Manager

Name: Name: Name:

Signature & Date Signature & Date Signature & Date

DS-DXB/DMS/F/005 – Employee Clearance Form

Office B-402 West wing, Lathifa Tower, Sheikh Zayed Road, Dubai United Arab Emirates