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Clearance Format Final

This document is a clearance certificate for an employee leaving their job. It contains sections to be filled out by different departments to confirm the employee has turned in equipment, paid outstanding balances, and addressed other exit matters. The header provides employee details like name, code, designation, department. Sections include confirming return of keys, laptops, ID cards from IT, HR, Admin and accounts. HR also tracks notice period, PF transfer and exit interview. The last section is for calculating final settlement of payables like salary, reimbursements and deducting advances to determine net payment. Sign off from heads of each department is required.

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Rajat Arora
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9K views2 pages

Clearance Format Final

This document is a clearance certificate for an employee leaving their job. It contains sections to be filled out by different departments to confirm the employee has turned in equipment, paid outstanding balances, and addressed other exit matters. The header provides employee details like name, code, designation, department. Sections include confirming return of keys, laptops, ID cards from IT, HR, Admin and accounts. HR also tracks notice period, PF transfer and exit interview. The last section is for calculating final settlement of payables like salary, reimbursements and deducting advances to determine net payment. Sign off from heads of each department is required.

Uploaded by

Rajat Arora
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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CLEARANCE CERTIFICATE

Employee name: Employee Location:


Code:
Designation: Level: Dept./Sub Dept:
Date of joining: Last day of work:
Date of resignation :
Contact Address: Landline Tel No:
Mobile No:
Email address:
Any Home
Loan Yes NO
From SBI
Employee
Any
Confirmation YES NO
Personal Yes NO
Loan
From SBI

OWN DEPARTMENT [Please indicate status as Yes/ N.A (not applicable) or fill in details.
Please do not keep any response blank]
Handover to Passwor Key Travel PACER
authorized ds s expenses/ Assessment of
person bills claimed employees
supervised
Documents/ Files/Calculator/ Any other Comments, if any:
Company Asset
Name: Signature:
Date:
ACCOUNTS
Outstanding Loans/ Advances: Outstanding bills/ clearing of
bills:
Total amount to be adjusted: Rs. Remarks:
Name: Signature:
Date:

IT
Lapto Any other LAN ID/ Lotus Computer Remarks:
p item Notes Storage
(specify) ID deleted on Devices
Name: Signature:
Date:
ADMINISTRATION
Mobile ID - Visiting Company
Phone Card Cards Books
Leave Status: PL: SL: CL: Remarks:
Name: Signature:
Date:
HUMAN RESOURCE
Notice Notice Pay paid Date
Period Amount Rs. vide d
PACER PF to be / Exit Interview
Assessment of Transferred Withdrawn done,
employees recorded &
supervised attached
Comments:
Name: Signature:
Date:
FULL AND FINAL SETTLEMENT
(To be filled by HR)

R/HRFormat/ClearanceFormat/PW 1/9/05
PAYABLE AMOUNT Amount (Rs)
1. Salary to be paid from………… to …………
2. Medical Reimbursement (if due) against bills
3. L.T.A (If due) against application form duly signed by the authorized
signatory
4. Telephone Reimbursements (if any) against bills
5. Gratuity (if applicable)
6. Any other payment (please specify)

RECOVERABLE AMOUNT
1. Advances (if any)
2. Tour Advances
3. Any other deduction (please specify)
NET PAYABLE NET RECOVERABLE
Rs. Rs.
PF Amount to be Transferred/ Withdrawn
Name: Signature:
Date:

R/HRFormat/ClearanceFormat/PW 1/9/05

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