PT MOJITEA JAYA INDONESIA

Alamat : Jl. Hos Cokroaminoto No 9

Email : mojitea@yahoo.com
Date:
CLEARANCE FORM

NAME : JOIN DATE :

ID : RESIGN DATE :
UNIT : PHONE NUMBER :
REASON OF LEAVING :

CLEARANCE ITEM
STATUS
ITEM APPROVAL
CLEAR PENDING
DOCUMENT Resignation Letter
Job Hands Over
ETC : …......................
UNIFORM Polo Shirt Mojitea
Apron
Bow Tie
ETC : …......................
FINANCE Sales Cash
Petty Cash
Last Salary
Loan
ETC : …......................
ASSETS Inventory
ETC : …......................
NOTES :

I, Mr/Ms …................................................. Hereby acknowledge that I have return the items mentioned above.
I understand that the items listed above are belong to PT Mojitea Jaya Indonesia. I hereby assure that I no
longer have belonging and assets of PT Mojitea Jaya Indonesia in my possesion.

Proposed By Approved By