Mobile Programming India Pvt Ltd.

EMPLOYEE EXIT CLEARANCE FORM

Section A

Exit Resigned and Performance Issue Termination Due to Admin.

Type Relieved Immediate Reasons
Relieving
1. Name of Employee

2. Employee Code

3. Designation and Department

4. Joining Date (as Employee)

5. Date of Resignation

6. Proposed Date of Relieving (Last working

day)
7. Present Address

8. Permanent Address

9. Personal Email ID

10. Mobile Number

11. Please specify the notice period served by you.

months days

12. Have you deposited compensation for short

notice if applicable?
(Please write NA if it’s not applicable and
EXEMPT if it has been exempted)

For Internal Use Only 1|P age

s

SECTION B
(For Technical Employees engaged on a client project onsite)
1. Client Name and Project Name

2. Client Location

3. Have you got approved all the timesheets till the date of de-
boarding from client office?

4. Were you issued any asset by the client?

5. If answer to point 4 is yes, have you returned and same to the

client and received necessary clearance? (Please enclose the
necessary clearance)

6. Have you completed the necessary de-boarding process with

the client?

Declaration and Confirmation by the respective CRM

(To be filled up by the CRM)

I do hereby confirm that Mr./Ms. (name of employee) has been duly de-
boarded from the office of client on (date) and the
employee has duly got approved all his timesheets till the date of de-boarding and has also got
necessary clearance after submission of client assets back to the client.

Signature of the CRM

Name of CRM: Name of Sales Director

Declaration and Confirmation by the respective

Employee Relationship Manager(ERM) i.e. HR SPOC

I do hereby confirm that Mr./Ms. has submitted and got approved

from the client, all the timesheets till the date of de-boarding from the client office and has also
submitted back to the client all the client assets as were issued to him/her and has got the same
acknowledged by the client.

Signature of the ERM (HR SPOC)

Name of the ERM

For Internal Use Only 2|P age

 SECTION C
(Only for the Technical Employees other than those engaged on a client project
onsite)

Current On Bench On Offshore Offshore Project -

Status Project Billable Shadow
1. Have you given necessary KT to the designated successor
employee? Please mention the name of successor employee or
your manager to whom the KT was given.
2. Have you transferred the ownership of Google sheet, Google
drive or any other cloud space where the company’s official data
has been saved by you, to the successor employee or your
reporting manager ?
3. If you are billable on an offshore project, please take clearance
from the respective Project Manager/CRM. Have you obtained
such clearance? Yes/No
4. If you have been Project Name CRM/ PM Name Clearance received
working on more than from the CRM/PM
one Offshore Project as Yes/No
a shared or shadow 1.
resource, then please 2.
share the name of 3.
Project and the 4.
CRM/PM names.
5. If you been assigned any client asset/testing device, have you
handed over the same to the successor employee or IT Team?
Yes/No
6. If the answer to point 5 is yes, please specify the name of the
person to whom those assets have been handed over by you.
Please also enclose a confirmation from such employee in this
regard.
7. Have you handed over the credentials of code repository and
project management tools, etc. to the successor or RMS or IT
team? If yes, please specify the name of the receiver of such
details.

Declaration and Confirmation by the designated person from RMS Team

(To be filled up by the RMS)

I do hereby confirm that Mr./Ms. has done the necessary KT to

Mr./Ms. (the successor or the manager) with reference to the Offshore
Project(s)

and has shared all the necessary credentials and information

with the said successor and I have checked and verified the same.

Signature of Designated RMS person Signature of the Reporting Manager

Name Name

For Internal Use Only 3|P age

 SECTION D
(For non-technical employees only)

1. Have you given the necessary KT to the

designated successor? If yes, please specify
the name of the successor and enclose the
confirmation from the successor employee.
2. Have you transferred the ownership of google
sheet or any folder in the Google Drive or any
other cloud space where the official data has
been saved by you, to the successor employee
or your reporting manager, as applicable?
3. Have you shared your mobile number, email
ID or any other contact details as point of
contact to any outsider/agencies/ vendors/
clients, etc.?
4. If yes, have you got the contact details updated
with such outsider by sending them the contact
details of your successor or manager as
applicable?

CONFIRMATION BY THE SUCCESSOR EMPLOYEE

I do hereby confirm that I have received necessary KT from Mr./Ms. and I am

satisfied with the information given to me by him/her.

Signature of the Successor Employee

Name

CONFIRMATION BY THE REPORTING MANAGER

I hereby confirm that Mr./Ms. has duly given his/her necessary

KT to Mr./Ms. and all the above mentioned point under Section D has been
taken care of by him/her.

Signature of the Reporting Manager

Name

For Internal Use Only 4|P age

 SECTION-E
(IT AND NETWORK RELATED INFORMATION)
Please share the following details (As and where applicable)
1. Your official email id
Password
2. For any portal (LinkedIn, Naukri, Monster, etc.), Tool (WebEx, Jira, Basecamp, etc.) or cloud space (Google Drive,
Dropbox, etc.) possessed by you for official purpose, please share the following details:
Portal/Claud Space User ID Password Shared with Confirmation of the
receiver

3. Have you shared the details of code repository where you have stored the source codes, etc. with the successor
employee or your manager or the IT Head? If yes please share the following the details:
Project Name Coding file name Handed over the details to Receivers
confirmation and sign

4. Have you handed over the company assets or client assets to the designated person from IT Team? If yes, please
share the following details:
Asset Type (Laptop, Asset Number as Damage of asset observed Asset Received
Mac Book, Mac Mini, marked by IT Team if any (you may have to (Name/Signature)
Mobile Phone, etc.)
compensate the company
for the damage to the
assets)

CONFIRMATION BY THE DESIGNATED PERSON FROM IT TEAM

I have checked the above details provided by Mr./Ms. and do hereby confirm that the
necessary IT related information has been obtained from him/her. We further confirm the following activity done by the
IT Team in relation to him/her.
Machine data backup and email data backup obtained/taken
Email Blocked
Domain ID Blocked
Bit bucket ID Blocked
SVN User ID Blocked
Extra-net Access & Ors
Client Repo / Server / (Any)
access Signature of the Designated Person
Name

For Internal Use Only 5|P age

 SECTION-F
(Accounts and Payroll Related information)

1. Have you submitted the client approved time sheets to the

Account Team for the purpose of billing? (Applicable only to
the onsite billable employees) If no, please obtain approval
and share. If approval not possible practically, please obtain
confirmation from the respective CRM and enclose.
2. Have you submitted to the accounts department all the ta x
saving documents in accordance with the declared amounts
of savings and expenditure as in the IT Declaration Form? If
no, please submit the same and obtain confirmation from
accounts team.
3. In case of short notice period being served, have you
deposited the compensation amount as per the terms of
employment agreement? If no, please deposit and obtain
receipt from the accounts department.
4. Have you got your address in the Salary account updated with
the bank so that your letters should not be coming to the
company address? If no, please get the address updated or the
account closed. Please share the copy of acknowledgement
of bank against the request for such changes.
5. In case your Salary account is going to be closed, then please Account type:
share your other Bank account details in which your last Beneficiary Name
month salary as applicable can be transferred. A/c No.
Bank Name
IFSC Code:
Branch

CONFIRMATION BY DESIGNATED PERSON FROM ACCOUNTS TEAM

I have checked the above information under section F given by

Mr./Ms. and do hereby confirm that he has taken care of all the desired
action from his side in relation to the above points.

Signature of the Designated Person

Name

For Internal Use Only 6|P age

 SECTION G
ADMINISTRATION TEAM CLEARANCE

1. ID Card/ Aceess Card surrendered Yes / No Signature/Name of the

Designated Person
2. All assigned office assets taken back

3. No dues checked from the canteen (if applicable)

SECTION H
(Miscellaneous Clearances)

1. Official What’s App Groups you are added to:

S. No. Group Name Group Left or Confirmation and sign of

Got removed group admin with name
Yes/No
1

2. Have you filled the Google Form of Exit Interview Questionnaire? Yes/No

For Internal Use Only 7|P age

 UNDERTAKING

I R/O have been

relieved from my duties from and I have handed over to
the office administrator; all documents, official correspondence, computer
programs, official yahoo/msn passwords given for client and intra company
interaction, identity card issued by the company, and any other document which
was in my possession during my service with MPIPL.
I do hereby undertake to abide the post terms and conditions of my
consulting/employment agreement excerpt of which are produced herein for
reference.

Clause 3 NON-DISCLOSURE OF INFORMATION OF COMPANY & CLIENTS. You shall

not, during the Term and for a period of two (2) years thereafter, disclose all or any part
of the Confidential Information to any person, firm, company, corporation, association or
any other entity for any reason or purpose whatsoever nor you shall use the information
for any personal benefits and against the interests of the company.

Clause 4.2 NON-SOLICITATION. You shall not offer or engage yourself for full time
or part time employment during the terms of employment with this company and for 2
years after leaving employment from this company, with any present clients of this
company with whom the employee was engaged either on-site or off-site by this company
in performance of any project of such client during the terms of employment of the
employee with this company.

Clause 5 NON-DISPARAGEMENT. During the term hereof and thereafter you leave the
company, You agree that you will not (nor will you cause or cooperate with others to)
publicly criticize, ridicule, disparage or defame the Company or its products, services,
subsidiaries, policies, directors, officers, shareholders, agents, affiliates or employees,
with or through any written or oral statement or image (including, but not limited to, any
statements made via websites, blogs, postings to the internet, or emails and whether or
not they are made anonymously or through the use of a pseudonym). You agree to provide
full cooperation and assistance in assisting the Company to investigate such statements
if the Company reasonably believes that you are the source of the statements.

I understand that the above covenants are necessary to maintain confidentiality and
protect the business interests of the company. Any breach of the post terms of my
Consulting/employment agreement shall cause irreparable loss and damages to the
company. I shall make myself liable to pay damages in case violating post terms and
conditions of my consulting/employment agreement.

I further do hereby undertake that while getting relieved from this company I
am not carrying out or in possession of any confidential data or information
relating to Mobile Programing or its group company or any of its client, either in
physical or digitized mode, the access/possession of which was given to me in
order to perform my duties during my employment with the company.

Dated:
Place:
NAME

For Internal Use Only 8|P age

Comments of the Reporting Manager

Reporting Manager’s Signature :

Date :

Comments of the Local HR Manager:

HR Manager’s Signature :
Date :

For Office use:

The above mentioned information and details have been verified and taken over.

Legal Department HR Department.

Date: Date:

All process relating to relieving of Mr./Ms. has been duly complied by

the employee and relieving documents can be signed by the ODC Head.

Process Department

Comments of the ODC Manager

Signature: ---------------------
Date : ---------------------

For Internal Use Only 9|P age