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CLEARANCE FORM

Updated: May 13

      CLEARANCE FORM

(To be completed before Relieving)



Mr./ Mrs./ Ms.:


UPI Code : 


Date of Resignation :


Date of Relieving :


Business Unit:


Date of Joining :


Business Title :


Location  :


Email id: 


Tel No.


Address  For Future Communication : 





Clearance Details

Clearance By:

Name of the Employee

Signature

BU / Functional Head





1

Business Unit Head’s clearance for relieving.

Business Unit Head

 

 

2

Exit Interview Form

Supervisor

 

 

3

All official documents/CDs/Process handed over

Supervisor

 

 

4

Personal Disk space cleared on Computers.

Supervisor

 

 

Remarks : 






Administration Department






5

Employee ID Card/Access Card

Admin

 

 

6

Drawers cleared and keys returned

Admin

 

 

7

Mobile handset and Sims Cards

Admin

 

 

8

Data Card

Admin

 

 

9

Balance Visiting Cards

Admin

 

 

10

Telephone connection (if any)

Admin

 

 

Remarks Admin :






IT Department


11

Lap Top / Desktop and Accessories

Local IT

 

 

12

Authorization Code for STD/ISD

Local IT

 

 

13

Deactivation from Mailing List

Local IT



14

Calling Cards

Local IT

 

 

Remarks IT Department :







CFO


15

Loans  /  Deposits

CFO

 

 

16

Company credit card

CFO


 

17

Settlement of all dues

CFO

 

 

18

Submission of all expense vouchers due.

CFO

 

 










Remarks by CFO :


HR


19

Intimation for deactivation of access card 

HR Person

 

 

20

Acceptance Letter subject to clearance of dues.

HR Person

 

 

21

Balance leave status

HR Person

________days;

 

22

Notice period to be recovered

HR Person

________days;

 

Remarks by HR :









HR Team :

23

Termination of record in software if any

HRSC Team

 

 


Stores


24

Equipment (if any)

Store in charge

 

 



Note: * This form should be returned to HR- Department, on or before the last working  

            day


        **Please do not keep any of the field empty, as incomplete form will not be 

            entertained


      ***Some of the fields may not be applicable to all, in such case please mention N/A


    **** Please submit the balance reimbursement and Income Tax proof documents 

            along with the clearance form






Employee  Signature: __________________________                          

Date :  _________________________________




Download PDF Document In English. (Rs.20/-)



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