HR NETWORK INC.

CLEARANCE FORM FOR OUTSOURCED EMPLOYEES

EMPLOYEE DATA:
Employee Name:Sherihan H. Ampaso Employee ID:
Position:Dealer Account Coordinator Deployment: Colours Tower Center, GF, Alabang-Zapote
Effectivity Date of Separation: December 29, 2023 Road Talon 1, Las Pinas Metro Manila
Last day of reporting to work: Decemeber 29, 2023

ATTESTATION ON EMPLOYEES LIABILITIES:

Please indicate below any accountabilities and/or liabilities that the above employee may have incurred under your
department/company, in the course of his/her deployment under HR Network, Inc. (HRNI)
DEPARTMENT ACCOUNTABILITIES Name & Signature Date Signed
Immediate Superior in Client/
Principal

Next Immediate Superior in

Client/ Principal

Human Resources in
Client/ Principal

Finance & Administration in

Client/ Principal

HRNI Admin Operations Dept. insurance coverage for the year/s

cash card SOA no/s:

HRNI Accounting Dept.

Note: Any unsettled accountabilities and/or liabilities as indicated above shall be held against the employee’s quitclaim and shall be
grounds for employee’s clearance to be put on hold until such time that said accountabilities and/or liabilities are fully settled.

Employee Acknowledgement

I hereby understand and agree that HR Network Inc. will process and release my quitclaim within 30 to maximum of 45
“working” days from receipt of the signed clearance and completeness of documents submitted.

Further, I hereby authorize HR Network Inc. to deduct from my quitclaim any liabilities or accountabilities I may have left with the
client/ principal and/or HR Network Inc.

Employee Signature: Date:

EMPLOYEE REMINDER STUB

Clearance Received By: Date Received:

Please follow up on: Tel: No.: