Exit Clearance Form

Employee Name: Employee No.: Date:

Designation: Department:

Last Date Worked:

Purpose: Resignation Termination Others (Specify):

Department: Item Date Cleared In-Charge Remarks

Work hand over

To be checked and

Department Head

Pending works, if any, listed given

signed off by

Department stamps handed over

Employee’s

Keys hand over (office, filing cabinets, etc.)

Equipment and materials hand over

E-mail account removed

To be checked and

Email diverted to E-mail ID

signed off by IT

Sim Card submitted

Department

Mobile Phone submitted

Computer/Laptop hand over

Car Keys
To be checked and
signed off by HR

Company stamps handed over

Notice Period completed

Department

Insurance cancellation – Medical & GLPA

FG Policy Cancellation
Settlement of employee’s fiscal account, bills paid,
loan/advances repaid
To be checked
and signed off

Department

Fines (if any), paid

by Finance

Petty cash settlement

Other comments:

Signatories:

Employee Head of Department Finance

Original – Employee Personal File. Copy – Employee