IT Exit Clearance Form

Nama :
Departement :
Position :
Efective Last Day :
Email :

Hardware Merk / Type / Tahun Tanggal serah Serial Number / Imei Received by: (sign)
terima awal and Date

Laptop

HP

SIM Card

HDD External

Laptop Bag

Mouse

Other

Software Confirm Comment Received by: (sign)

and Date

Confirm Deletion of
Employee From System
access and Password

Confirm deletion /
suspension of email
address and redirection

Confirm deletion /
suspension of gdrive
address and redirection

Confirm deletion /
factory reset of laptop
and another device

Note
 Jakarta, …../…../…...

(employee Signature) (Lead Signature) (Head Signature)