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Department Clearance Form

This document is a department clearance form for an employee leaving a company. It collects information about the employee like name, employee number, designation and location. It also details any company property issued to the employee that needs to be returned or accounted for like a calculator, ID card, company vehicle. The form also specifies the employee's leave balance, attendance for the month, allowances to be paid and recovered, and gets signatures for authorization and verification. Notes provide instructions to send the completed form to personnel a week before relieving and inform them of any additional leave or amounts due to the company.

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Rajdeep Dey
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99 views1 page

Department Clearance Form

This document is a department clearance form for an employee leaving a company. It collects information about the employee like name, employee number, designation and location. It also details any company property issued to the employee that needs to be returned or accounted for like a calculator, ID card, company vehicle. The form also specifies the employee's leave balance, attendance for the month, allowances to be paid and recovered, and gets signatures for authorization and verification. Notes provide instructions to send the completed form to personnel a week before relieving and inform them of any additional leave or amounts due to the company.

Uploaded by

Rajdeep Dey
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DEPARTMENT CLEARENCE FORM

Emp Name:

Emp No:

Grade:

DOJ:

DOR:

DOL:

Designation:

Location:

Region:

Basic Salary:

Gross Salary:

Sl
No

Item / Description

Remarks ( Returned / Not returned / Not


Provided )

Calculator

ID Card & Visiting Cards

Mobile / Simcard

Company Vehicle

Any other Company Property ( Pl. Specify )

a.

b.
c.
6

Any other advance

LEAVE BALANCE ( Earned Leave only )

ATTENDENCE ( For the month of )


No. Of days attended:

Leave balance to be paid:


No of days salary payable:

LTA:

ALLOWANCES TO BE PAID OT TO BE RECOVERED


Ent:

Mediclaim:

Magazine:
Superannuation:
Authorised by

Verified by

Name

Signature / Date Name

Signature / Date

Note:

I Completed form shall be sent to Personnel department at HO atleast one week before the probable date of
relieving
II Any leave availed by the employee after forewarding this to personnel department and before relieving shall be informed
immediately to personnel department.
III Any ampount / property due tot eh company shall be clearly specified
IV Handing over form should be attached along with this.

Ref. No. HRA/F/015/1 Rev.Date : 01-07-2004


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