New Statesman Media LLP

Separation Clearance Form

Important Notes:

1. The respective supervisor of the employee leaving the company is required to ensure that the full and final
process is being adhered to
2. Human Resources Team will issue relieving letter and process full and final settlement payment only after receiving
confirmation from all departments that the outstanding dues have been cleared to their satisfaction
3. Below requested information is mandatory to provide for a smooth settlement and disbursement
4. Please note no exceptions will be entertained.

Name Gender Male / Female

Date of Joining in
Employee ID
Group company
Designation
Date of Resignation
Division
Tenure in the
Last Working Day
organization
* 15 days
Notice Period to be
served as per * 30 days Notice Period
policy(Please tick the * 60 days Served (in days)
appropriate one) * 90 days

* Served Complete Notice

Notice Period Status
Reporting Manager
(Please tick the * Waived off Name & Signature
appropriate one)
* Buyout

Reason for Leaving Date of Clearance

Mobile Number & Address for

Personal Email ID Communication

HR Comments:

HR Name & Signature

Date:
 New Statesman Media LLP
Please obtain signatures from appropriate departments as indicated below:

Employee Name Employee ID

Outstanding / Dues /
S.No. Department Description Yes No N/A
Remarks Signature

1 Employee Exit Questionnaire submitted online Yes No N/A

Reporting Manager to sign for the clearance based on work

Yes No N/A
and acceptance of resignation.
Websites access (Specify List) Yes No N/A
Operations Tools access (Specify List) Yes No N/A
Clearance - FTP access? (Specify list) Yes No N/A
2
Reporting Others (Specify List) Yes No N/A
Manager Access Removal from all Authoring Tools: Are any passwords /
Yes No N/A
credentials shared? if yes then is the passwords reset done?
Is there any remote server’s access? Yes No N/A
Any access to resources managed at UK / other location? Yes No N/A
Database Access : Access to be removed from databases Yes No N/A
Sales Force Access (Applicable for Sales/Distribution/Client
3 Client Admin Admin, Credit Control) :
Yes No N/A
Access to be removed from Sales force and mail to concerned
manager
Access Removal from all Internal & external websites & FTP
4 Software Yes No N/A
Removal
Travel Advances Yes No N/A
5 Finance Relocation expense amount to be recovered Yes No N/A
Any other finance Advances Yes No N/A
ID Card Submitted Yes No N/A
Library Books returned Yes No N/A
Storage Keys Submitted Yes No N/A
6 Administration
Business cards Submitted Yes No NA
Access Cards Submitted Yes No N/A
Blackberry/ Mobile Phones/ Sim Cards- Returned Yes No N/A
LAN Access disabled Yes No N/A
E-mail ID Disabled Yes No N/A
Access to be removed from specific applications used Yes No N/A
Phone access disabled Yes No N/A
7 IT
Name to be removed from group e-mail ids Yes No N/A
Laptop/Pen-drive/ Headphones Yes No N/A
VPN Access disabled Yes No N/A
UK Virtual number Yes No N/A
Exit Interview Yes No N/A
Personal File Completion Yes No N/A
IP Protection Acknowledgement–Form to be signed and
Yes No N/A
submitted
8 HR
HRMS Updation: Status to be updated as relieved Yes No N/A
Recipients list to be updated in HRMS (only for Managers):
Manager’s name to be deleted from recipients list from Yes No N/A
GlobalData Admin mails in HRMS.

Employee signature
Date: