CLEARANCE CERTIFICATE

A. Employee Information Date: _____________

Employee ID Department/ Section

Employee Name Designation
Date of Joining Last Working Day
I declare that the above named employee □ has resigned / □ has been terminated, and we release him/her after
necessary satisfaction.
Dept. Head Name Signature

B. Clearance from Other Departments

NAME DEPARTMENT NAME SIGNATURE
Department
□ Knowledge transfer □ Manuals
□ Others __________________________________
IT
□ Email access □ Windows login □ Server access disabled
□ Lap top & Accessories □ Headsets □ BlackBerry & Accessories
□ Others ___________________________________
Administration
□ Locker Key □ Vehicle □ Uniforms
□ Vehicle & Registration □ Mobile & Accessories □ SIM
□ Others _________________________________
Safety
□ Shoes □ Helmet
Human Resources
□ Resignation Employees Status: □On Probation □ Confirmed
□ Exit Interview Type of Separation □ Volunteer □ Non - Volunteer
□ Personal File Leave Balance: CL ____ SL ____ AL ____

□ Attendance Sheet Remarks:__________________________________

□ Others_____________ __________________________________
I declare that the necessary requirement in respect of the above named employee has been fulfilled before
sending to the Finance Department for payment of Final Dues.

_________________
(Human Resource)
C. Final Dues
Salary for the Month of _________ ( No. of Days work)
Gratuity ( In case of Eligibility)
Other
Deductions : Notice Pay
Income Tax

NET PAYABLE VIDE CHECK NO.__________ Dated__________

UNDERTAKING BY SEPERATED EMPLOYEE

I CONFIRM THAT I HAVE RECEIVED ALL MY DUES AND THERE IS NOTHING RECEIVABLE.

Name of Employee: ____________________________ Signature __________________________ Date: __________________