GROUP LOGO

COMPANY NAME

Employee Clearance Form

COMPANY LOGO

This form is used to certify that all office property and other dues have been returned and rights to access property or services have been appropriately discontinued Managers must clear employee of all departmental obligations. Employee Information Name of the employee junaid khan Department Sales ________________________________________________ Employment No. (SAP) (Legacy) _________________ Date Of Separation 28-Aug-12 _________________

Forwarding Address

HO __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 9760143274

Telephone No. Type of Separation Resignation Retirement Transfer

Yes

Yes

To _______________________________________________

Department Clearance The following have been surrendered, which were entrusted during employment Items Department Keys for work station and other office areas Office Stationary item - Calculators, letter heads etc. Office Equipments - Electronic gadgets SOP Manual / Business Plans Project plans Database of vendor / suppliers / other outside contacts IT Office Equipments - Laptops and IT accessories Password - SAP / Restricted access (deactivated) HR Library Material / Card Identification Badge / Access Card / Bus Pass Office books with person at his office / desk Leave Balance (if any)PL STORES Safety Equipments, etc. Received / Amount Payable Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received No Never received Name & Signature Date Remarks

Department Clearance Items Finance / Payroll Credit Cards Petty Cash Travel Advances Salary Advance Rent Advance Housing Loan Balance E.V.F.S Loan Balance Festival Advance Balance Company Loan with Interest Personal Loan Medical Loan Co-operative Society Dues Loan / Advances Medical Expenses Reimbursed LTA Secreterial Power of Attorney Legal Involve in any case Admin Locker Keys Cellular Phone Vehicle Personal Call Charges Transit Accommodation Occupancy Charges Residence Phone Company Quarters ( Inventory verified ) Any Other ( Please Specify ) Received / Amount Payable Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Never received Name & Signature Date Remarks

All performance evaluation reports on all staff for whom I have Evaluation responsibility have been prepared I have Completed the Exit Interview All payments related to PF / SAF / Pension may be deposited to ( Wherever applicable ) Sent by a Bank Account Check No.

Yes / No. Yes / No. _______________

Proof of Investment declared through IT Declaration _____________________________________________________________ Permanent Account No. ( PAN no. ) _____________________________________________________________

Employee's Signature Date

Department Head's Signature 28-Aug-12 Date

HR Signature Date

Payroll Date