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Employee Separation Clearance Form

The Separation Clearance Form is a document used to facilitate the resignation process of an employee, detailing necessary information such as employee name, designation, and dates of joining and resignation. It includes sections for various departments to confirm the return of company assets and settle financial matters. The form also requires a declaration regarding the ownership of intellectual property created during employment.

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120 views2 pages

Employee Separation Clearance Form

The Separation Clearance Form is a document used to facilitate the resignation process of an employee, detailing necessary information such as employee name, designation, and dates of joining and resignation. It includes sections for various departments to confirm the return of company assets and settle financial matters. The form also requires a declaration regarding the ownership of intellectual property created during employment.

Uploaded by

abeysarma
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

SEPARATION CLEARENCE FORM

EMPLOYEE NAME: EMPLOYEE CODE:


DESIGNATION: GRADE:
LOCATION : DEPARTMENT:

DATE OF JOINING: DATE OF ACCEPTENCE OF RESIGNATION :

LAST WORKING DAY:


REMARKS FROM RESPECTIVE DEPARTMENT HEAD:
Handover process completed satisfactory :- Yes : No:
Charges handed over to:
Any other (Please Specify)
Name and Signature of HOD

ACCOUNTS AND FINANCE:


[Link]. Documents/Assets Amount Authorized Signatory

1 Travel Advance
2 Outstanding Loans / Advances
3 Rental Deposit
4 Credit Card
5 Any other (Please Specify)
INFORMATION TECHNOLOGY:
[Link]. Documents/Assets Surrendered/Deactivated/ Authorized Signatory
Remark
1 Desktop / Laptop
2 Data Card
3 Login ID / E-mail/ Password
4 PEN /USB Drive
5 Any other (Please Specify)
6 SAP ID/ Concure
ADMINISTRATION
[Link]. Documents/Assets Surrendered/Deactivated/ Authorized Signatory
Remark
1 Mobile Handset / SIM Card
2 Res. Tel. Deposit
3 Companies Property (Furniture /
Equipment)
4 Any other (Please Specify)
SECRETARIAL
[Link]. Documents/Assets Remark Authorized Signatory

1
2

P.T.O.
HUMAN RESOURCES
[Link]. Documents/Assets Surrendered/Deactiva Authorized Signatory
ted/ Remark
1 Exit Interview Conducted
2 Notice pay Recovery (No. of Days)
3 Any Other Recovery or Pay (Please
4 Leave Balance
4.1 Privilege Leave (No. Of Days)
4.2 Casual Leave (No. Of Days)
4.3 Sick Leave (No. Of Days
5 Canteen Recovery (if applicable)

6 Access/I – Card, Visiting Card,


Drawer Key or Any other (Please
specify)
7 Loan Balance
8 Gyansarovar (E- Library)
9 Any other (Please Specify)

Address for Communication (for all future correspondence i.e. Full & Final Settlement Cheques, Relieving letter etc.)

Mobile Number: Res. / Emergency Contact No.

Email Id:

Declaration

I hereby agree and acknowledge that all Intellectual Property (including but not limited to copyrights, designs,
trademarks, patents, logos) whatsoever in my possession or created by me for <<Company Name>> during the course
of my employment with <<Company Name>> are exclusive property of <<Company Name>> and I shall not, at any
time, assert or claim any right or interest thereto. I also agree that if proof of investment is not given at the time of
final settlement of dues, the entire income will be taken as taxable.

(Signature of the Employee) Date

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