Sheet1
CLEARANCE CHECKLIST
Nama Karyawan / Employee Name NANDA APRILIA
Nomor Induk / ID No. 22018829
Jabatan - Grade / Position - Grade (PIC / Non PIC) SA
SBU - Divisi / SBU - Division SS2G (SPORT STATION ROXY JEMBER)
Tanggal Terakhir Bekerja / Resignation Date 31-Dec-22
Dengan ini menyerahkan kembali seluruh asset, perlengkapan milik Perusahaan yang diserahkan kepada saya, beserta penyelesaian biaya-biaya
perorangan yang terjadi selama berdinas di lingkungan PT. Mitra Adiperkasa, Tbk. & Groups :
No Item Related Department
Surat Pengunduran Diri
1 Superior
Resignation Letter
Temporer / Kontrak I / Kontrak II / Kontrak II < 3 th / Probation / Permanent
2 2ndcontract but < 3 yrs
Temporer / 1stcontract / 2ndcontract / 2ndcontract but < 3 yrs / Probation / PermanentTemporer / 1stcontract / 2ndcontract / 2ndcontract but < 3 yrs / Probation / P
Kehilangan Barang – Rp 0
3 OIC / Superior
Missing Item
Outstanding Setoran Penjualan Harian Toko (Cash and Voucher) Retail Admin
4
Outstanding Store Sales Deposit Daily Cash and Voucher) (RACS)
Lain-lain : Seragam, Kunci, Exit Interview, dll
5 HR SBU
Others : Uniform, Lock, Exit Interview, etc.
Pinjaman Buku - Perpustakaan
6 Training
Book - Library
Sisa Cuti (ABSENSI PERIODE TERAKHIR dilampirkan) ( 7Hari)
7
Annual Leave Balance (attach last attendance) Personnel
Kartu (ID KARYAWAN, ASURANSI KESEHATAN, TRAVEL dilampirkan)Kartu (ID KARYAWAN,
Admin
8 ASURANSI KESEHATAN, TRAVEL dilampirkan)
ID Card (Employee, Health, Travel Insurance)
Pinjaman Koperasi / BPR / Perusahaan
9 Payroll
Loan
Kelebihan Pemeliharaan Kesehatan Personnel
10
Overlimit of Health Insurance Admin
Kas Kecil, Penyelesaian Kas Bon
11 Finance
Petty Cash, Outstanding Advance
Mobil / Motor
12
Car / Motor Cycle General
Handphone / BlackBerry, Kunci Apartment Affair
13
Mobilephone / BlackBerry, Apartment Key
Kartu Kredit Perusahaan Corporate
14
Corporate Credit Card Treasury
Page 1
Sheet1
Deactivated by
15 Please fill in E-mail Account :
IT / MIS
Komputer Jinjing
16 IT / MIS
Notebook Computer
Diserahkan Oleh / Prepared by, Disetujui Oleh / Approved by,
#MACRO?
NANDA APRILIA _______________________
(Karyawan / Employee) (Nama jelas dan Jabatan)
Catatan / Note :
Jadwal pembayaran
Diterima Payroll Transfer ke reken
≤ Tgl 5 Tgl 15
≤ Tgl 15 Tgl 28
Page 2
Sheet1
KLIST
PRILIA
ORT STATION ROXY JEMBER)
penyelesaian biaya-biaya
Yes / Staff Floor
Office
No Non PIC PIC
Yes
No
#MACRO?
No
#MACRO?
No
#MACRO?
Yes
#MACRO?
No
#MACRO?
Yes
#MACRO?
Yes
#MACRO?
Yes
#MACRO?
Page 3
Sheet1
Disetujui Oleh / Approved by, Diterima Oleh / Received by,
_______________________ ________________________
(Nama jelas dan Jabatan) (Personnel Admin Head)
Transfer ke rekening staff
Tgl 15
Tgl 28
Page 4