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_________

Private Bag X8
Brixton
2019
Tel: (+27 11) 726 - 5206
Fax: (+27 11) 726 - 5627
e-mail: HR@nrc.co.za
http://www.nrc.co.za/

RETURN OF COMPANY ASSETS FORM

Name: _____________________________ Emp No: __________________

Unit: _________________________ Designation: ____________________

The responsible line manager advised to attend to retain:

ACTION YES NO NA
Keys
Access Card(s)
Petrol card
Cell phone
Parking disk(s)
Text Books
Product manual(s)
Strategy docs
Study materials
Laptop and other computer equipment
Petty Cash
Cancel systems access
Dialysis consumables and equipment
Other company property/assets

I _________________________________hereby acknowledge that I have returned all


company property/assets indicated in tick boxes to my line manager or company
agent.

__________________ ________________
EMPLOYEE DATE

I ___________________________ hereby confirm that I have received all company


property/assets indicated in tick boxes.

_________________ ________________
LINE MANAGER DATE

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