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EMPLOYEE CLEARANCE/QUITCLAIMS

Name: Hired Date:

Designation: Status:

Department: Exit Date:

Reason for leaving: [ ] Transfer/Reassignment [ ] Resignation [ ] Termination

Nature of reason: [ ] Better career opportunity [ ] Travel abroad [ ] Family concerns

[ ] Medical issue [ ] others: ______________

Requiring clearance before the release of last payments.

1. Return of company-issued properties;

2. Proper turn-over of duties and responsibilities before leaving the company.
3. Settlement of accountabilities, if any.

Payroll department and HR department will not release or pay any monies or documents until all the
necessary requirements imposed by the management on an employee to settle all debts and obligations,
including company properties or documents, to be cleared of any accountability.

Note that employees with existing loans with the company and any government agencies will be
deducted to his/her separation pay.

The relevant items listed below must be returned before the employee leaves the company.

DEPARTMENT / SIGNATURE / DATE Assets and Liabilities

OPERATIONS DEPARTMENT LAPTOP, CELLPHONE, OFFICE KEY, HMO card,

mobile device or any company properties.

ACCOUNTING CASH LOAN:

SALARY LOAN (to any gov. )

HUMAN RESOURCE Resignation letter

After completing the signature listed below you may submit it to the HR department.
I hereby authorize Decon Medical Supplies and Equipment Trading to deduct any monetary debts owing
to the company, including salary loan, liabilities resulting from fault or negligence from my Last pay.

I furthermore acknowledge that I have no argument with said Debt or liabilities to the company which
were incurred by myself, and for which I am solely responsible.

Signed on this ______ day of month ______ in the year ______.

Employee Signature

Date

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ACKNOWLEDGEMENT RECEIPT

This is to acknowledge that I received my separation pay amounting to ₱_____________ at DECON

MEDICAL SUPPLIES AND EQUIPMENT TRADING on __________________. I confirm that I hereby release
the company from all liability, financial or otherwise, for my employment. I will not make any claims
against the company.

Signed on this ______ day of month ______ in the year ______.

Signature overprinted name