[Company Logo][Company Name]
- Ref. No.:
- [Reference Number]
- Date:
- [Date]
- Handover Form Ref.:
- [Handover Form Number]
- Reason:
- Resignation / Termination / Retirement / Transfer / Recall
1. Employee Details
| Employee Name | [Employee Name] |
|---|
| Employee ID | [Employee ID] |
|---|
| Designation | [Designation] |
|---|
| Department | [Department] |
|---|
| Date of Joining | [Date of Joining] |
|---|
| Last Working Day | [Last Working Day] |
|---|
2. Asset Reconciliation
| Asset ID | Description / Make / Model | Serial No. | Condition at Issue | Returned (Y/N) | Condition at Return | Shortage / Damage (₹) |
|---|
| [Asset ID] | [Laptop – Make / Model] | [Serial Number] | [Condition] | Y / N | [Condition] | [Amount] |
| [Asset ID] | [Mobile / SIM] | [IMEI / Mobile Number] | [Condition] | Y / N | [Condition] | [Amount] |
| [Asset ID] | [ID / Access Card] | [Card Number] | [Condition] | Y / N | [Condition] | [Amount] |
| [Asset ID] | [Keys / Furniture] | [Key Number] | [Condition] | Y / N | [Condition] | [Amount] |
| [Asset ID] | [Tools / Samples / Uniform] | [Serial Number] | [Condition] | Y / N | [Condition] | [Amount] |
3. Valuation Summary
| Basis of valuation: Depreciated value / Repair estimate / Policy rate | |
|---|
| Total shortage and damage: ₹[Amount] | |
|---|
| Amount waived: ₹[Amount] (approved by [Authorised Signatory]) | |
|---|
| Net amount to be adjusted in F&F: ₹[Amount] | |
|---|
4. Employee Comments
[Employee comments on the condition assessment or valuation, if any]
5. Department Clearances
| Department | Items Cleared | Name | Signature | Date |
|---|
| IT | Yes / Pending | [IT Executive Name] | [Signature] | [DD/MM/YYYY] |
| Administration | Yes / Pending | [Admin Name] | [Signature] | [DD/MM/YYYY] |
| Security | Yes / Pending | [Security Officer] | [Signature] | [DD/MM/YYYY] |
| Stores | Yes / Pending | [Stores In-charge] | [Signature] | [DD/MM/YYYY] |
6. Declaration
I confirm that I have returned all company assets in my possession except those noted above, and that I hold no other property of [Company Name]. I have been informed of the valuation of any shortage or damage.
Employee
[Employee Name]Date:
[Date]Approved by
[Authorised Signatory][Designation]Date:
[Date]