Employment Exit Clearance Form

Effective on this day of ____ year _________, I ______________________________________________________________

legal age of ______________________________________________________________________________________ is leaving the

service due to ___________________________________________.

And hereby confirms that the above employee has completed his/ her handing - taking and doesn’t have any balance / dues

in office; this also to confirm that the company is cleared and settled all such salary, cash bond, commissions, benefits and in any

form of wages and all responsibilities as an employer to me as employee of Northern Spa – Philippines.

_________________________________________
Applicant / Employees Printed Name & Signature

_________________________________________
Authorized/ Employer Printed Name & Signature