SSEDUKS/QMS 2019/HR/Clearance Form/Revision 0

SS Eduks Management Consultants Pvt. Ltd.

NO DUES / CLEARANCE FORM

Name of the Employee Employee Code

Unit\Department Reporting to

Date of Joining Date of Leaving

Please √
Dept. / Section Yes No Initials
Employee’s Department
To handover files handled by him/her
Soft/hard copies (list required)
Floppies & CDs used
Others
IT Section
PC/Laptop

Others
HR & Administration
ID Card

Health/Insurance Card

Mobile Phone /Sim Card

Keys for drawers, Cabinets, etc.,

Books borrowed, if any

Educational Declaration, if any

Company Car (if any)

Others
Payroll: Total Payment
Final Settlement Benefits

Any Loan Against salary

Others
Annual Leave Settlement
Encashment of_____ leaves
 SSEDUKS/QMS 2019/HR/Clearance Form/Revision 0

Department Clearance

DEPARTMENT NAME SIGNATURE DATE REMARKS

Reporting Manager
Department Head
Finance Dept.
Administration Dept
Human Resources Dept.
Managing Director

Note: -
 Settlement will be made only after obtaining this certificate duly approved by all concerned.
 The employee has returned all the company property.
 In-case of Company property has not been submitted to the concern department then the amount
will be deducted from Full & Final Settlement

Name of the Employee : _____________________________

Signature of Employee : _____________________________

Date : _____________________________

FOR OFFICE USE ONLY

This is to certify that Mr./ Ms. …………………………….. has no outstanding dues as of ………………………………..