Annexure X1

Full and Final Settlement Form

Employee Name: ________________________Employee No.: ____________ Designation:

_______________

Department: _______________ Location: _________________ Reporting to:

__________________________

Human Resources: Date of Joining:

Date of Resignation:

Date of Relieving:

Notice period required: Yes No

Notice period served: Yes No

Notice pay waiver: Yes No

(If Yes, attach approval note)

Notice pay recovery: No. of Days ______________

Leave Balance: No. of Days ______________

Net payable / recovery: No. of Days ______________

Any other: ________________________

HR Manager/Head Name & Signature: ________________________

Employee’s Department Vendor payments & bills cleared: Yes No

Documents/Data Handover: Yes No

Name & Signature of Line Manager: ________________________

HOD Name & Signature: ________________________

Information Technology Return of all devices: SIM Yes No

Phone Yes No
Laptop Yes No

Passwords (Official Email/ Personal Yes No

Email ID used for Official purpose/
Desktop/ Online accounts for official
Purpose):

Return of Access Card: Yes No

Any other: ________________________

 Name & Signature of IT Representative: ________________________

Administration Surrender of:

1) Company owned vehicle:
2) Keys:
3) Stationary
4) ID Card
5) Any other

Name & Signature of Admin Representative: _________________________

Signature of the Employee: ____________________________________ Date: ___________________

Future Correspondence Address: ____________________________________________________________

Contact Nos. (Tel./Mobile): ____________________________________________________________

The form needs to be taken to departments in the sequence it is formed. The form in the end needs to be
submitted to HR by outgoing employee. HR in turn will submit it to the accounts department for further
processing.

Finance (Accounts / Payroll) Medical: _________________________

Travel: _________________________

Imprest: _________________________

Any other: _________________________

Salary Advance: __________________________

Loan: __________________________

LTA: __________________________

Total to be paid / recovered from __________________________

the employee:

Name & Signature of Accounts Rep.: _____________________________

Guidelines for the Outgoing employee:

 The resignation letter must be submitted to the Reporting Manager with a copy to HR Manager.
 HOD and HR Head shall be the final approving authorities.
 In case of resignation acceptance by the company, HR will issue a Resignation Acceptance Letter
mentioning the date of relieving well in advance soon after receiving the original resignation letter with
HOD’s and Head HR approval.
 To enable the Company to issue you the Full and Final Settlement Cheque, you need to observe the
following guidelines.
o The F&F Settlement Form shall be issued to outgoing employee by the HR manager as soon as
Resignation Acceptance Letter is issued by HR (but not more than 4 weeks before the relieving day)
o Its outgoing employee’s personal responsibility to get this Full and Final Settlement Form duly
signed by all concerned before leaving the Company. Inability to do so will eventually lead to
inordinate delay in your clearance. In case the person leaves the company without getting the F&F
Settlement Form signed by the all concerned signatories, he/she still have to take the personal
responsibility of completing it through his/her own follow-ups from outside Encompass.