CLEARANCE AND ACCOUNTABILITY FORM

NAME OF EMPLOYEE David L. Domingo EMPLOYEE ID

109030129
POSITION CSR DEPARTMENT/PROGRAM Verizon Business
DATE OF HIRE December 7, 2021 NAME OF SUPERVISOR Anne Macapagal / OM Julie Calderon

LAST DAY OF WORK July 25, 2022 DATE OF SEPARATION July 29, 2022

MOBILE NO. PERSONAL EMAIL david.domingo0305@gmail.com

09236507069

ACCOUNTABILITY NAME & SIGNATURE OF DATE

DEPARTMENT DETAILS (Indicate if CLEAR or AMOUNT OF ACCOUNTABILITY or
N/A if not applicable) CLEARING OFFICER SIGNED

 Turnover of all tasks

MANAGER/TRAINER  Approve TAMS DTR until last day of work.
(Attach dispute form if any) IMMEDIATE MANAGER/TRAINER
 Laptop  Docking Station Executive Approval to waive missing items:
IT  Laptop Bag  RSA Token _______________________ ____________
 Others _______________ Signature over printed name Date IT
 Access Badge ____________
 Company ID ______________
 Headset ______________
 Masterlock ______________

ADMINISTRATION  Yjack Cord ______________

 USB Adapter ______________
 Speaker ______________
 Pedestal/Cabinet Keys ______________
 Others
____________ ______________ ADMINISTRATION

Exit Documents received

 YES
 NO
HR LABOR RELATIONS Payment of Liquidated  YES
Damages  NO
BTO Conversion Eligibility
 YES
 NO HR LABOR RELATIONS
Government #s  SSS
 Philhealth
HRIS  HDMF
 TIN
 Exit Interview Ref # ______________________ HRIS
Deduct SSS Loan Balance?  Yes
 No
If NO, is waiver from new
HR COMPENSATION & employer submitted?  Yes
BENEFITS Please attach waiver.  No
 HMO Card/s
BTO Conversion (# of hours) _____________________ hours COMPENSATION & BENEFITS
*For Managers & Up
Filed all liquidation for cash advance, petty cash
FINANCE fund and gift check.
 Yes  No FINANCE

EMPLOYEE CHECKLIST
 Filed all medical reimbursement following HR guidelines. Claims submitted after submission of clearance will no longer be accepted.
 Reviewed PDY/TAMS attendance until last day of work.
 Settled property accountabilities before the effective date of separation with the company.
I acknowledge agreement on the above identified accountabilities. Therefore, I hereby authorize Afni Philippines, Inc. to deduct the full amount of accountabilities stated herein from
my final pay. I further acknowledge that my final pay shall be processed within 45 working days from submission of completed clearance.

David L. Domingo
Conforme: Signature over Printed Name Date Submitted

ACKNOWLEDGEMENT RECEIPT FORM

Thank you for completing your clearance.

Name:
Date Complete:
Received by:
Expected Final Pay Release Date:
We will send an email notification coming from PHFinalPayInquiry@afni.com to your personal email address within 45 working days from the submission of the
employee clearance form to the HR POC. The notification will include the instructions regarding the release of your final pay.
You can also send us an email to PHFinalPayInquiry@afni.com.