No.

Tove Leeds Certification &

Revision No. 0
Inspection
Date 28-06-2022

Employee Clearance Form

To: Human Resources Department Date:

Form: Designation:

Last Day of Service (Date):

The relevant items must be returned before leaving the company.

Payroll department will not pay any monies or hand over any documents until all
the necessary signatures appear on this form and the form is handed to the
Human Resources Department.

Sr.
ITEMS ISSUED / TO BE CLEARED  SIGNATURE / RECEIVED BY DATE
No.

25-26-
1 Human Resources:
2022

1.1 Termination Letter Signed and Returned

1.2 Exit Interview

2 Administration:

2.1 Access Card (Employee Card)

2.2 Office Keys

2.3 Residence Keys

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 No.
Tove Leeds Certification &
Revision No. 0
Inspection
Date 28-06-2022

Employee Clearance Form

2.4 Car Keys and Documents

2.5 Medical Insurance Card

2.6 Web ID Closure

2.7 Copy of Controlled Documents

2.8 Mobile Phone (if applicable)

2.9 Sim Card

2.10 Dues Clearance

Laptop and Accessories

1. Bag
2. Charger
2.11
3. Mouse
4. Keyboard
5. USB

 Verified that all of the above items are collected to the respective department and
employee is declared as Cleared from any belongings.

Signed By Employee:

______________________________ __________________ ___________

Full Name Signature Date
Signed By Managing Director:

______________________________ __________________ ___________

Full Name Signature Date

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