MORE EVIDENCE, LESS POVERTY

Form A- Employee Clearance Form

INSTRUCTIONS:
The HR and Admin Coordinator routes this form to all the clearing officers so that accountabilities
are fully checked before clearance is granted. Once this form is completed, HR and Admin will
forward this to Finance for final pay processing.

Name of Employee : ANIFE M. LANO Last Day of Employment: April 6, 2024

Employee ID ___N/A______________ Position: Field Coordinator

Type of Separation ☐Voluntary ☐ End of Contract

A. Employee Responsibilities
I have surrendered all [tick that apply] which were entrusted to me during my employment.
Staff ID Hand Over Report

Medicard ID Office Keys

Laptop/ Tablet Others (specify) _______________

Serial number: _________________________________________

• I understand that my IPA email address will be deactivated the day after my last official workday,
and I have notified appropriate email contacts of this change.
• I understand that I have an on-going responsibility to maintain the confidentiality of any data or
information on to which I may have had access during my employment.
• I have cleared all matters pertaining to funds and project expenditures. I understand that if I owe
any outstanding monies, it may be withheld from my final paycheck.

Employee Signature: ___ Date: ___03/06/2024___________

B. The following supervisors shall make sure and sign that the employee has already fulfilled all
employee responsibilities pertaining to separation as stated in section A.

1. Relevant Supervisor/s [ Field Coordinator, Field Manager, Research Associate, and

Budget holder]

Name Position Date Signature

Michelle Ann Santos Field Manager

Phidel Marion Vineles Research Associate

Rene Marlon Panti Research Manager

7th Floor (Unit 7B) Belvedere Towers, San Miguel Avenue, Ortigas Center,
Pasig, Metro Manila, Philippines

www.poverty-action.org
 MORE EVIDENCE, LESS POVERTY

The Supervisors should also make sure that the timesheet is submitted, Receipt of Hand over
reports and survey equipment. Notifying the following department(s) to delete and update the
relevant information as per policy.

2. Finance and Operations [ To update payroll, HRIS, and delete IT access]

Name Position Date Signature

Norma Angelica Avila HR Admin Coordinator

Ann Mayuga Operations Manager

Christina Masalonga Senior Finance Manager

_____________________________
Country Director

Distribution:
Supervisors
HR and Operations
Finance
File copy

7th Floor (Unit 7B) Belvedere Towers, San Miguel Avenue, Ortigas Center,
Pasig, Metro Manila, Philippines

www.poverty-action.org