NO DUES/ CLEARANCE FORM

Emp. No: _______________________

Name of Employee: ____________________________________ Date of Joining: __________________

Department: _________________________________________ Date of Resign: __________________

Designation: _________________________________________ Date of Relieving: ________________

SR. DEPARTMENT DUES ANY IF SIGNATURE

NO.
1 HEAD OF DEPARTMENT (In-charge of Dept)
2 FINANCE / ACCOUNT (Mr. Sohail)
3 MATERIAL / PURCHASE/STORE (UNIFORM) (Mr Daud)
4 FOOD AND BEVERAGES / CANTEEN
5 INFO TECHNOLOGY (IT)
6 HOUSEKEEPING / LINEN (Mr Vinod)
7 LABORATORY (Mr Omkar)
8 BIO-MEDICAL ENGG. (MAINTENANCE) (Mr Rohit Sir)
9 MEDICAL RECORD ( Mr. Ayub)
10 IPD BILLING (Mr. Sohail)
11 HUMAN RESOURCES (ID-CARD) (Admin)
12 Medical Store (Mr Jadhav sir)
13 Security Head (Mr Taqee)

AO Sign Director Sign