PAKISTAN REVENUE AUTOMATION (PVT.
) LIMITED
CLEARANCE FORM
Dated:___________________
It is certified that I _____________________________ designation(Last) ________________________DOJ__________
DOR__________ Pay Group_____ Salary__________handed over all assets/material assigned to me by the company
to respective Department. Please issue the clearance certificate. Bank Account #: ______________________________
Bank Name & Branch: __________________________Emp. Code: ___________ Contact No:_____________________
IBAN#___________________________________ CNIC________________________Signatures:____________________
Clearance Form
S.# Company Asset/Document/Receivable Yes No Not applicable Department/Received By
1 Official Books/Literature
2 Any Company's Software / material
Concerned HoD/HoW
3 Laptop/P.C
Store Section
4 Portable Internet Devise
5 Mobile Set
6 Any Other item:___________________________________
Manager (Admin. & Store)
7 Any Advance Cash/Imprest
8 Misc. Receivable: Warid/Telephone
9 TA/DA Advance
Finance Department
10 Company ID Card
11 Health Insurance Card
12 Leave without Pay (if any)
13 Any inquiry pending against him:
14 Leave Encashment
Earned Leave Balance for encashment: ___________________________ Manager (HR)
Note:After execution a copy should be sent to Accounts Department for payment of final dues.
Head of HR & Admin.