Oct 152 min read

CLEARANCE FORM

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 :

S.No	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 :

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

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.10/-)

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