[Company Logo] [Company Name]
Ref. No.: [Reference Number] Date: [Date] Key Issue Form Ref.: [Issue Form Number] Reason: Exit / Transfer / Leave cover ended / Lock change Returning Key Holder Name [Employee Name] Employee ID [Employee ID] Designation [Designation] Premises / Branch [Work Location] Last Working Day / Handover Date [Date]
Key-wise Return Key No. / Tag Code Lock / Door / Cabinet Copies Issued Copies Returned Tested in Lock Handed To [Key Number] Main entrance / shutter [Number] [Number] Yes / No Admin / [Next Key Holder] [Key Number] Store room / record room [Number] [Number] Yes / No Admin / [Next Key Holder] [Key Number] Cabinet / pedestal [Number] [Number] Yes / No Admin / [Next Key Holder] [Key Number] [Other Lock] [Number] [Number] Yes / No Admin / [Next Key Holder]
Missing Keys and Security Actions Keys not returned [Key Numbers / None] Explanation [Details] Lock change required: Yes / No – Lock changed on [DD/MM/YYYY] Cost of lock change (if recoverable as per policy): ₹[Amount]
Alarm / shutter code changed Safe combination changed (if applicable) Duplicate key set verified with Admin Key register updatedIncoming Key Holder (if direct handover) Name [Next Key Holder] Employee ID [Employee ID] New key issue form ref. [Reference Number]
Declaration I have returned all keys issued to me as listed above and confirm that I have not kept or made any copy of these keys.
Returned by
[Employee Name] Date:
[Date]
Received by
[Next Key Holder] Date:
[Date]
Verified by
[Admin Name] Administration
Date:
[Date]