DocuSign Envelope ID: 0E73117A-6B52-4376-AC06-39829B3E5856

EMPLOYEE CLEARANCE CHECKLIST

‫نموذج اخالء طرف ومخالصة‬
EMPLOYEE NAME: :‫اسم الموظف‬ EMP. N0: ‫رقم الموظف‬ DATE: :‫التاريخ‬
Mohamad Said Hamza Miro 1731714 04-Mar-22
JOB TITLE: :‫المسمى الوظيفي‬ DEPARTMENT: :‫االدارة‬
Storekeeper CGD WH DC # 36
An employee is required to return the Company’s properties to the respective Department / Business Unit before leaving the service of
AAW. He/she is instructed to bring this form to the concerned departments as stated below to obtain Clearance before collection of final
settlement pay.
Employee's Department: (Returned / Replaced / Damaged for charge / Etc.) ‫ادارة الموظف‬
ITEM ‫العهدة‬
_____________________________________________________________________________________________

REMARKS ‫مالحظات‬
____________________________________________(Cleared)__________________________________________
Cleared by:

Line Manager / Department Manager

Finance Department : (Returned / Replaced / Damaged for charge / Etc.) ‫ادارة المالية‬

ITEM ‫العهدة‬
______________________________________________________________________________________________

REMARKS ‫مالحظات‬
______________________________________________________________________________________________
Cleared by:
Line Manager / Department Manager

ICT Department : (Returned / Replaced / Damaged for charge / Etc.) ‫ادارة المعلومات والتكنولوجيا‬

Email Address (If Applicable) Phone Extension Name (If Applicable) Any other related activities from ICT

______________________________________________________________________________________________

REMARKS ‫مالحظات‬
______________________________________________________________________________________________

Cleared by:
Line Manager / Department Manager

HUMAN RESOURCES & ADMINISTRATION DEPARTMENT: (Returned / Replaced / Damaged for charge / Etc.)

Medical Insurance Passport Keys Employee Badge

_____________________________________________________________________________________________

REMARKS ‫مالحظات‬
______________________________________________________________________________________________

____________________________________ _____________________________
HR&A Administrator GM - HR&A Manager

The above details have been noted by ______________________________ and final settlement pay has been / will be
made on __________________________________.

ECC-HRF23 Human Resources & Admin. Ver.1 June ‘12