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Employee Clearance Form

Inventory, Logistics & IT

S# Item Serial Qty Date Hand over to Name & Dept Sign Remarks

1 Laptop / PC Name :

2 Mobile & Model

3 SIM (Number Issued

Date: Department Head Name & Sig:

Finance

Action Taken (Cleared/


S# Item Amount Action Taken By (Name) Sign Remarks
Pending)

1 Loan or Advance

2 Provident Fund

Date: Department Head Name & Sig:

Human Resource

Action Taken (Cleared/


S# Item Amount (if) Action Taken By (Name) Sign Remarks
Pending)

1 Pay & Settlement

Cancellation of Medical /
2
Insurance Card

3 Last Pay Certificate

4 Experience Letter

5 Offical Email & HRMS ID

Date: Department Head Name & Sig:


Administration & Coordination

Action Taken (Cleared/


S# Item Amount Action Taken By (Name) Sign Remarks
Pending)

1 Official Card

2 Keys

3 Stamp

4 Click Up ID

5 Cafeteria / Kitchen

Date: Department Head Name & Sig:

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