ENTRANCE & EXIT CLEARANCE FORM - BO

NAME :
POSITION :
DATE EMPLOYED :
LAST WORKING DAY : (diisi oleh BAN Support)
EFFECTIVE DATE OF RESIGNATION : (diisi oleh BAN Support)

Current Department ITE Departement GAF Departement CAS Departement

No Items Yes No Sign No Items Yes No Sign No Items Yes No Sign No Items Yes No Sign
1 Resignation Letter 1 Google Account 1 Laptop Returned + Charger 1 Termination Form
2 Exit Interview 2 Printer + Cabel 2 Form Pengalihan Pemeliharaan Polis
3 List Handover 3 HDMI
4 ID Card 4 Modem
5 Business Card 5 Password Laptop

I, the undersigned, hereby state that I shall return to PT. Panin Dai-ichi Life any documents and properties, including any notes, information or memorandum in every kind (softcopy and hardcopy),
containing any threat secrets, business, confidential information, or any matters related to PT. Panin Dai-ichi Life and my employment ("Confidential Information") in my possesion
or custody at the termination of my employment at anytime during the course of employment or any time thereafter which given to me or shall be acquired or received by me during my tenure.

Undersigned by, Approved by, Approved by, Approved by, Approved by,

Employee Head of Sales Head of ITE Head of GAF Head of CAS

My Contact details after I leave the company

Telp / Mobile No :
Email ID :
Contact Address :