CLEARANCE CERTIFICATE

COMPLETE NAME: POSITION:

MAILING ADDRESS:

DEPARTMENT IMMEDIATE SUPERVISOR:

DATE HIRED: REASON FOR SEPARATION:

DATE SEPARATED: ABSORBED RESIGNED TERMINATED DUE TO:

I. ACCOUNTABILITIES
The accountabilities of the above-mentioned employee are as follows:
CLEARANCE
SIGNATORIES ACCOUNTABILITIES REMARKS / COMMENTS DATE
SIGNATURE
MARKETING AND OPERATIONS DEPARTMENT

❑ Immediate Superior

❑ ROM

❑ GM / CMOO / RM

❑ PRES & COO

HUMAN RESOURCES AND ADMIN DEPARTMENT

❑ COMPENSATION AND BENEFITS

❑ ADMIN

❑ HUMAN RESOURCES

❑ COMPLIANCE

IT DEPARTMENT

❑ IT /MIS

FINANCE AND ACCOUNTING DEPARTMENT

❑ PAYROLL

❑ ACCOUNTING

❑ FINANCE

NOTE: Signature of authorized signing officer per section/unit signifies that the above-mentioned employee is cleared of any/all accountabilities from the department. Should
there be any accountability that will arise in the future of cleared employee, signing officer will be held accountable and/or responsible.
II. COMPENSATION & BENEFITS DUE
DETAILS TOTAL AMOUNT REMARKS
Wage/Salary
13th Month Pay
Reimbursements (if any)
OTHERS

Deductions

TOTAL COMPENSATION AMOUNT

Computed & Prepared By: Verified Correct By:

(Signature Over Printed Name/Date) (Signature Over Printed Name/Date)

Date of Check Release Approved By:

NOTE: All separated employees must turn-over the following before release of final pay/check: [ ] Employee ID Card [ ] ATM Card w/ balance inquiry receipt (if
HelloMoney Account no need to surrender HelloMoney Card )