Employee Separation & Clearance Form

Part 1: To be accomplished by HR Department

Name
Date Prepared Position Status Upon Separation
Date Hired Department
Date Separated Nature of Separation ____End of Contract ____Resignation ____Termination ____Others (Specify)
Date of Notice Reason of Separation
Attachments Submitted □ Resignation Letter □ End of Contract Notice □ Termination Letter □ Separation Letter
Part 2: To be accomplished by Separating Employee

Complete Mailing Address of Separating Employee Contact Number Signature of Employee

Part 3: To be accomplished by “ALL” Clearing DepartmentS
Clearing
Functional Department/s Accountabilities Remarks
Officer/Head
Immediate Department (Check one)
□ Sales Resignation Letter with approved last
□ Trade Marketing day of work; Finished turnover of
□ Supply Chain documents & files; Screen shot of
__Fleet/Procurement desktop/laptop showing file contents
turned-over; Systems & Procedures
__Demand
turnover; Projects & programs
__Warehouse turnover; Indicate any financial
□ MIS/IT accountabilities; Cabinet keys, drawer
□ Credit & Billing keys (if applicable); Confidential
□ Treasury documents & files; Indicate other
□ Audit accountabilities that needs to be
□ Accounting turned-over.
□ HRD
HRD ID Returned, Leave Balance Validated,
Timekeeping Summary for last Payroll
printed & attached. HMO (if applicable)
cancelled /ID surrendered; Exit
Interview Form submitted
Credit & Billing Hanging Deductions
Uncollected Invoices
Clearance from Immediate Superior
MIS/IT Email Access
Proximity/Biometrics Access
WiFi Access
Network Access/User ID
PC/Laptop (including access)
File Backup Access
Others
Fleet/Procurement Mobile Phone & SIM
Latest Billing Statement of Phone
Company Vehicle with key
Treasury Petty Cash
Cash Card / BPI Corp Lane Card
OR
Accounting Cash Advances
Revolving Fund
Emergency Loan Balance
Other Deductions/Dues
Last Payroll Computed
13th Month Pay
SL Conversion (if applicable)
Retirement (If applicable)
Other Loans (SSS, Pag-IBIG, BIR
Form 2316
Audit

CLEARED OF ALL FINANCIAL ACCOUNTABILITIES

Chief Operating Officer President & CEO