[Company Logo][Company Name]
EXIT CLEARANCE FORM
- Form No.:
- [Reference Number]
- Date Issued:
- [Date]
Part A: Employee Details
| Employee Name | |
|---|---|
| Employee ID | |
| Designation | |
| Department | |
| Work Location | |
| Date of Joining | |
| Date of Resignation / Separation | |
| Last Working Day | |
| Type of Separation (Resignation / Retirement / Termination / Contract End) |
Part B: Departmental Clearance
| Department | Items to Check | Dues / Recovery (₹) | Cleared By (Name) | Signature and Date |
|---|---|---|---|---|
| Reporting Manager | Handover note, files, pending work | [Amount] | [Reporting Manager] | |
| IT | Laptop, accessories, email and system access, software licences | [Amount] | [Name] | |
| Admin | ID card, access card, locker key, parking sticker, mobile / SIM | [Amount] | [Name] | |
| Finance / Accounts | Salary advance, loan, travel advance, expense claims, corporate card | [Amount] | [Name] | |
| Stores / Library | Tools, uniforms, books, safety equipment | [Amount] | [Name] | |
| HR | Exit interview, leave balance, insurance, PF and gratuity forms | [Amount] | [HR Name] |