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Facility Clearance Form

Date of Resignation Date of submission of Form


Employee Name
Employee Code
Project
Manager/HOD

Items to be Returned Returned Kindly specify Reason if not


Returned

Yes No
1 Laptop Lock/Keys
2 Pedestal Key
3 Cub Board Key
4 Access Card
5 Parking Sticker
6 SEZ Card
7 ECN Phone
8 Landline Phone
Sign Name Date
Security Supervisor
Facility Executive-Soft
Facility In charge-GP

1. Mails send for discontinuing of transport service ……………… Yes/No/Not Availing Services

Employee has to send the scan copy of this form to facility.gp@ericsson.com after completing all the
above formalities.

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