KEFRI/F/HR/01
KENYA FORESTRY RESEARCH INSTITUTE
CLEARANCE CERTIFICATE
PART ONE
(To be completed by the Officer leaving the service or transferred)
1. Name: ……………………………………………………………………………………………..
2. Personal Number…………………………………………………………………………………
3. Designation: …………………………………. Job Group ………………………………
4. Date of first appointment:
……………………………………………………………………….
5. Terms of Service: ………………………………………………………………………………..
6. Termination/or transfer effective date:
………………………………………………………..
7. *Reasons for leaving: (Resignation/Dismissal/Non-Renewal of Agreement/
Retirement/Transfer)
* Delete which does not apply)
8. Address: …………………………………………………………………………………………
…………………………………………………………………………………………
………………………………………………………………………………………….
Signed:
…………………………………………………………………………………………..
Designation:
………………………………………………………………………………………
Date: ……………………………………………………………………………………………….
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PART TWO
(To be completed by the Departmental Head)
I hereby certify that Dr/Mr/Mrs/Miss
……………………………………………………………………….
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KEFRI/F/HR/01
has been instructed to return all Government property in his/her custody
immediately.
Date………………………………… Signed………………………………………………
HEAD OF
DIVISION/NPC/PROJECT
MANAGER/CENTRE DIRECTOR
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PART THREE: LIBRARY
I certify that the above named Officer has returned all books to the library, except for
the loss or damage of the following books.
BOOKS COST (KSHS.) BOOKS COST (KSHS.)
Date: ……………………………………… Signed …………………………………….
LIBRARIAN, KEFRI
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PART FOUR: STORES
I certify that the above named Officer has returned all equipments issued on loan from
the main stores, except for the loss or damage of the following articles:
ITEM COST (KSHS.) ITEM COST (KSHS.)
Date: ……………………………………….. Signed:
………………………………………
SENIOR SUPPLIES OFFICER,
KEFRI
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KEFRI/F/HR/01
PART FIVE: JANITORS
I certify that the above named Officer has returned all keys/stores issued by Janitors
except for the loss or damage of the following articles:
ITEM COST (KSHS.) ITEM COST (KSHS.)
Date: ………………………………………..
Date: ……………………………………….. Signed:
………………………………………
SENIOR JANITOR, KEFRI
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PART SIX: KEFRI HOUSE
I certify that the above named Officer has cleared the accommodation at KEFRI and
has cleared/not cleared all the bills due and has surrendered the keys for the rooms.
ITEM COST (KSHS.) ITEM COST (KSHS.)
Date………………………………. Signed……………………………………….
MANAGER, KEFRI HOUSE
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PART SEVEN: SALARIES SECTION
Salary released after deductions/no deduction of the above have been effected.
Date………………………………. Signed……………………………………….
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KEFRI/F/HR/01
OFFICER-IN-CHARGE, SALARIES, KEFRI
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PART EIGHT: IMPREST SECTION
I confirm that this Officer has no outstanding imprest/has an outstanding imprest of
Kshs…………………………………………………………………………………………………...
Date………………………………. Signed……………………………………….
OFFICER –IN-CHARGE
IMPREST SECTION, KEFRI
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PART NINE: WELFARE
I confirm that the Officer has no outstanding Loan /has an outstanding loan of
Kshs……………………………………………………………………………………………………..
Date………………………………. Signature ……………………………………….
TREASURER
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PART TEN: CLINIC
I confirm that the Officer has no outstanding bill/has an outstanding bill of
Kshs…………………………….
Date………………………………. Signature ……………………………………….
CLINICAL OFFICER
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PART ELEVEN: MEDICAL SCHEME
I confirm that the Officer has cleared with the Scheme and has no outstanding claim.
Date………………………………. Signature ……………………………………….
SECRETARY/KEFRI MEDICAL SCHEME
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KEFRI/F/HR/01
PART TWELVE: CO-OPERATIVE SOCIETY
(HARAMBEE, UKULIMA, ASILI, UTAFITI, SHERIA ETC)
I confirm that the Officer has no outstanding Loan.
The Officer has a liability of Kshs…………………. to be cleared wholly/partially
by off-setting shares
We request that you effect recovery of Kshs………………….. from the
Guarantors
Assist the SACCO to recover the balance of Kshs…………………….
from the Officer’s final dues.
Date………………………………. Signature ……………………………………….
LOAN MANAGER
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PART THIRTEEN: BANK LOAN (KCB , EQUITY, KIAMBU DAIRY, FAMILY FINANCE
ETC)
I confirm that the Officer has no outstanding Loan with the Bank.
The Officer has a liability of Kshs………………………………… to be cleared.
We request that you assist the bank to recover the balance from final dues.
Date………………………………….. Signature……………………………..
LOAN MANAGER
