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Doc.

Number : BIZ/GA/HC/P07/Form001
Version : 5.0
EXIT CLEARANCE FORM
Effective Date : 12 January 2023
Classification : Internal

Name : Adi Diana Suhartono Position : Security


NIK : 2401842 Department
Join Date : 1 Januari 2024 Workplacement : Branch Majalengka
Resignation Date :

Resignation Reason:

Administrative Check List


A PIC Signature
Hands over Direct Superior

Robi Agustriadi
Name/Date
B IT OPERATION DEPARTMENT Check Note PIC Signature
Revoke Access - Billing
Revoke Access - CRM
Compliment Biznet Home - Change Email
Compliment Biznet Home - Change Plan
Compliment Biznet Home - Deduct Period
Others Name/Date
C IT HELPDESK DEPARTMENT Check Note PIC Signature
Account User dan Email
Forward Email (Max 30 hari) to :
Access Card
PC/Laptop SN :
Status PC/Laptop : Normal/Tidak Normal
Backup Data
Format Data
Others Name/Date
D FINANCE DEPARTMENT Check Note PIC Signature
Cash Advance
Petty Cash
Corporate Credit Card
Employee Loan
Lost of Company's Assets
Others Name/Date
E GA DEPARTEMENT Check Note PIC Signature
ID Card
Building Access Card
Parking Card
Poloshirt
Uniform
Operational Transportation (Car/Motorcycle)
Corporate Online transportation
Others Name/Date
F HC DEPARTEMENT Check Note PIC Signature
Inactive Intranet System
Inactive SAP
Inactive Talenta
Insurance Card
Business Card
Inactive BPJS (if any)
Inactive Equity (if any)
Others Name/Date
This form is to declare that this employee has cleared for resignation.

Employee Dept. Head HC Dept.


Name : Adi Diana Suhartono Name : Robi Agustriadi Name :
Date : Date : 1 Februari 2024 Date :
1 Februari 2024

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