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It is the responsibility of the employee leaving the organization to fill this form and hand it
over to Human Resources to ensure prompt settlement of his/her account:
Personal Information:
Name: ___________________________________________________________
Position: ___________________________________________________________
Department Details:
What are the reason(s) for you to leaving Protinus Infotech Pvt. Ltd.? (Check all that apply)
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Is, there is anything that Protinus Infotech Pvt. Ltd. could have done differently that would have
changed or delayed your decision?
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Why: ________________________________________________________________________________
Is there any particular point you would like to record (in strictest confidential between you and
management) which may help management be aware of certain factors of which they might be
unaware?
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(SIGNATURE OF HR MANAGER)