Clearance Form
Employee Name : Resignation Submission Date:
Employee ID : Last Working Day :
Designation : Notice Period :
Department : Contact Mobile No. :
Date of Joining : Email Address :
Reason for Leaving:
Employee Signature :_______________________________ Date:
Employees’ Declaration:
I have surrendered all (check all that apply) which were entrusted to me during my employment and
hereby declaring that other than the below, I have no other assets of Company with me. If later it
has been identified any Company asset belongs to me, I shall be liable to handover those or pay the
amount which shall be decided by the Company:
Job ID Card: Yes No Office Stationery:
Cellular Phone & SIM: Pen-drive :
Laptop/Desktop: Vehicle :
Printer: Technical Tools:
Files/Documents: Others :
WhatsApp group removed :
Domain email deactivated or password changed: Yes No
Date of deactivation: ---------------------------------------
IT Assets takeover : Yes No
Employee access control removed:
Details of the Assets: --------------------------------------------------------------------------------------------------------
Data Backup handover: ----------------------------------------------------------------------------------------------------
Employee’s Name: ----------------------------------------- Signature: -----------------------------Date:
Receiver’s Name: ----------------------------------------- Signature: ----------------------------- Date:
Head of Department:
Responsibilities Handover : Yes No
Responsibilities Taken by : employee’s name Employee’s ID: ______________
Last Working Day :
Remarks :
Department Head’s Name: ------------------------------------------ Signature: ---------------------------------------
Accounts & Finance Department:
Any financial obligation/Outstanding /Advance : Yes No
If yes then what is the amount to be adjusted :
Travel settlement Status/Unsettle amount: ________________________________________
Any outstanding/payable with the Employee: ___________________________________________
Name : --------------------------------------Signature: ------------------------------------ Date: -------------------------
HR & Admin Department:
Any Company sponsored training Availed:
If yes, total amount paid by Company: _______________Receivable Amount (if any): ___________
Leave Balance:
Salary Payable:
Employment Status: Contractual/Probation/Confirmed
Notice Period Deduction/Payment:
Any other payment/deduction:
Handover note received: Yes No
HR Personnel: ------------------------------------ Signature: ------------------------------- Date: ---------------------
HR Head Approval:
Comments (if any):
Signature: ___________________________________ Date: ______________________