Rachelle M

Clearance Authorization Form

Pagapulangan
Emp Code: Date Hired:
Name: Effectivity:
Division: Position:

As part of my employment with NLEX Corporation, I understand that the following items

were temporarily issued to me for the purpose of my employment. These items may include,

please check box(es) that apply:

Desktop/ Laptop HMO Card NLEX Badge

Cellphone *Principal RFID
Sim card *Dependents Corporate Credit Card
PPE Cert of Transfer Charge Insurance Claims
Company ID Car Plan Keys IOU
Building Access Card Fleet Card Revolving Fund
System Access Card Asset Transfer Turnover
Accountability Form
Cash Advance

Should any of these items not be returned upon separation, I understand my signature authorizes the Company
to make a payroll deduction to cover the cost of replacement.

My signature authorized NLEX Corporation to process and deduct from my salary and other
remuneration of any or all money/accountabilities due to the Company. I also confirm that NLEX
Corporation is not liable for settling the outstanding balance of my government loan(s)
from SSS and/or Pag-IBIG due to my separation.

Employee Signature Date