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Clearance Form

This document is a clearance form for departing staff which requires signatures from various departments to confirm the employee has returned all company property and settled any outstanding financial matters. It collects information such as the employee's name, position, contact details, department, and last day of work as well as signatures from finance, ICT, admin, and P&C departments to verify the employee has cleared all accounts. Upon completion, the form is submitted for the supervisor's endorsement and confirmation of the employee's eligibility for rehire.

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hmmohiuddin1001
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59 views2 pages

Clearance Form

This document is a clearance form for departing staff which requires signatures from various departments to confirm the employee has returned all company property and settled any outstanding financial matters. It collects information such as the employee's name, position, contact details, department, and last day of work as well as signatures from finance, ICT, admin, and P&C departments to verify the employee has cleared all accounts. Upon completion, the form is submitted for the supervisor's endorsement and confirmation of the employee's eligibility for rehire.

Uploaded by

hmmohiuddin1001
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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CLEARANCE FORM

Name of Staff: HR ID Number:


Department: WD ID Number:
Division/ADP/Project: Position:
Contact Number (Personal): Last day of Work:
Home Address: Personal E-mail:

Finance Department
(NO/ ADP/Project) Cleared Pending Remarks
Salary
Travel advance/ settlements
Outstanding cash advance(s)
Outstanding loans from PF
Monthly LDR
Other (e.g. petty cash, personal courier, etc.)

Name & Signature: _____________________ Date: _______________

ICT Department

Particulars Handed over Pending Person responsible / Remarks


Laptop + Charger
Modem
External HDD
Pen Drive
Mobile
Notes Traveler
WebEx Account
E-mail account status & any ongoing
requirements (Applications used & security
levels should be closed immediately.)
Others

Name & Signature: ________________________ Date: _______________


Admin Department

Particulars Handed over Pending Person responsible / Remarks


SIM Card
Pending bills (mobile & other)
Business Card
Key/s
Others

Name & Signature: __________________________ Date: _______________

P&C Department

Particulars Received/Cleared on Person responsible/Remarks


Exit Interview form
Identity Card
RRRC ID Card
Settlement of Benefits
Exit Interview and Questionnaire
Guardian Life Insurance Cards
Learning and Development (Materials
/ Modules from trainings attended,
Reimbursement of Training Cost)
Others

Name & Signature: Date: ______________

(FOR OFFICE USE ONLY)


Overall clearance from Immediate Supervisor / Manager / RFD
Endorsement of tasks / deliverables / pending projects (Please use separate sheet/sheets for details)
Eligibility for Rehire:
YES Reason: _ ____________________________________
NO Reason: ______________________________________
Confirmed leave accruals
YES Annual Leave Balance days as of Last Working Day.
NO
Learning Agreement
YES (If yes, please enclose details with employee’s signature)
NO

Name & Signature: ___________________________ Date: _______________

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