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Clearance Form - NEW

This document is a clearance certificate used to process an employee's departure from a company. It contains sections to record the employee's information, clearances from different departments to return equipment and documents, final payment details, and an undertaking signed by the employee confirming receipt of all dues. Departments provide sign-off that necessary requirements were fulfilled before sending the certificate to finance for final payment processing.

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Muhammad Imran
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3K views1 page

Clearance Form - NEW

This document is a clearance certificate used to process an employee's departure from a company. It contains sections to record the employee's information, clearances from different departments to return equipment and documents, final payment details, and an undertaking signed by the employee confirming receipt of all dues. Departments provide sign-off that necessary requirements were fulfilled before sending the certificate to finance for final payment processing.

Uploaded by

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

A. Employee Information Date: _____________

Employee ID Department/ Section


Employee Name Designation
Date of Joining Last Working Day
I declare that the above named employee □ has resigned / □ has been terminated, and we release him/her after
necessary satisfaction.
Dept. Head Name Signature

B. Clearance from Other Departments


NAME DEPARTMENT NAME SIGNATURE
Department
□ Knowledge transfer □ Manuals
□ Others __________________________________
IT
□ Email access □ Windows login □ Server access disabled
□ Lap top & Accessories □ Headsets □ BlackBerry & Accessories
□ Others ___________________________________
Administration
□ Locker Key □ Vehicle □ Uniforms
□ Vehicle & Registration □ Mobile & Accessories □ SIM
□ Others _________________________________
Safety
□ Shoes □ Helmet
Human Resources
□ Resignation Employees Status: □On Probation □ Confirmed
□ Exit Interview Type of Separation □ Volunteer □ Non - Volunteer
□ Personal File Leave Balance: CL ____ SL ____ AL ____

□ Attendance Sheet Remarks:__________________________________

□ Others_____________ __________________________________
I declare that the necessary requirement in respect of the above named employee has been fulfilled before
sending to the Finance Department for payment of Final Dues.

_________________
(Human Resource)
C. Final Dues
Salary for the Month of _________ ( No. of Days work)
Gratuity ( In case of Eligibility)
Other
Deductions : Notice Pay
Income Tax

NET PAYABLE VIDE CHECK NO.__________ Dated__________

UNDERTAKING BY SEPERATED EMPLOYEE

I CONFIRM THAT I HAVE RECEIVED ALL MY DUES AND THERE IS NOTHING RECEIVABLE.

Name of Employee: ____________________________ Signature __________________________ Date: __________________

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