[Company Logo][Company Name]
FULL AND FINAL SETTLEMENT STATEMENT
- F&F No.:
- [Reference Number]
- Date of Preparation:
- [Date]
A. Employee Details
| Particulars | Details | Particulars | 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] |
| Total Service | [Years] years [Months] months | Separation Type | [Resignation / Termination / Retirement] |
| Monthly Basic + DA (₹) | [Basic Salary] | Monthly Gross (₹) | [Amount] |
| PAN | [PAN] | UAN | [UAN] |
B. Earnings
| S. No. | Component | Basis of Calculation | Amount (₹) |
|---|---|---|---|
| 1 | Salary for days worked in final month | [Days] days x gross per day | [Amount] |
| 2 | Leave encashment | [Days] days x [basic / basic + DA] per day | [Amount] |
| 3 | Statutory bonus / ex-gratia | As per Payment of Bonus rules / policy, pro-rata | [Amount] |
| 4 | Gratuity (if eligible) | 15/26 x last Basic + DA x completed years | [Amount] |
| 5 | Variable pay / incentive due | As per policy | [Amount] |
| 6 | Salary in lieu of notice (if employer-initiated) | [Days] days x gross per day | [Amount] |
| 7 | Approved reimbursements | As per finance clearance | [Amount] |
| Total Earnings (A) | [Amount] |