Name:_________________________ Position: __________________

Employee No.:__________________ Department: _______________

I hereby apply for clearance from money, property and accountabilities for purpose of:

____ RESIGNATION _____ INDEFINITE LEAVE _____ RETIREMENT

____ TRANSFER _____ OTHER MODES (Please specify): ________________

EFFECTIVITY/ INCLUSIVE PERIOD: _________________

__________________________
Name and signature of Employee

CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES

Not
Cleared Cleared Name of Clearing Officer Signature

Human Resource Department

Financial Services

Payroll Department

Security Services

Legal Affairs Office

CLEARANCE FROM WORK RELATED ACCOUNTABILITIES

We hereby certify that the applicant ________________________is CLEARED of any work-related

accountabilities from this Office/Company .

_____________________ ____________________
Immediate Supervisor Head of Office