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Full & Final Settlement Document Template

This document outlines an employee's resignation and requests for final settlement details. It includes: 1) The employee's resignation details and confirmation they have no other claims. 2) A list of pending dues to include in the final settlement, such as unpaid salary, travel expenses, and loans/advances to deduct. 3) A settlement clearance form for managers to confirm the employee has returned all company property and documents and that there are no other outstanding financial matters.

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aparna k
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6K views3 pages

Full & Final Settlement Document Template

This document outlines an employee's resignation and requests for final settlement details. It includes: 1) The employee's resignation details and confirmation they have no other claims. 2) A list of pending dues to include in the final settlement, such as unpaid salary, travel expenses, and loans/advances to deduct. 3) A settlement clearance form for managers to confirm the employee has returned all company property and documents and that there are no other outstanding financial matters.

Uploaded by

aparna k
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
  • Employees' Final Settlement Form
  • Settlement Clearance and Document Possession Form
  • Material/Amount Due Clearance Form

Employees’ Dues particulars to be included in Full & Final Settlement.

(For Payroll Department)

 TO BE FILLED BY THE EMPLOYEE

I Mr. __________________________________________ (Emp. No. ___________,


Location_______________ ) have resigned from the services of the company as on date
_________________ and being relieved from the Company w.e.f. dated _____________. I have no
claims of what so ever nature which includes re-instatement and re-employment also on the management
as described

Pending dues to be included in my final settlement are as under: -


1) Salary for the month of _____________ for _____days not received earlier.

2) Travel Expenses statement for the period _________ to ________ for Rs. _________ for which travel
expense statement enclosed herewith duly authorized by Department Manager or HOD.

3) Advance / Loan with me Rs. _____________ to be deducted from my final settlement dues.

4) Other dues to be taken into account not specified in the list given above: ( Kindly give details of the
same)

5) Specify if authorized signatory of any company matter/ document Yes/ No ____________ Signature
by HOD ____________

Signature by HOD ____________


Signature of employee
Name: Name of Dept. Manager _________________

Address: Authorized by Dept. Manager ____________

Authorized by HOD: ___________________


(To be retained by Accounts Department)

SETTLEMENT CLEARANCE ( to be filled by the Dept. Manager)

Name of the employee: Employee Code:

Department: Designation:

Date of joining: Resigned on:

Salary for the month of ________________ not received earlier

Company’s’ Documents Nos. Signature of a person


to whom charge given
1)
2)
3)
4)
5)

Company’s Property Possession Person’s signature to


whom handed over (If yes, please give details)
1) House accommodation Yes/No
2) Vehicle Yes/No
3) Telephone Yes/No
4) Equipments Yes/No
5) Others Yes/No
6) Files pass words Yes/No
Advance Status:
1) Vehicle Loan Yes/No
2) Housing Loan Yes/No
3) Housing Loan Yes/No
4) Personal Loan Yes/No
5) Salary Advance Yes/No
6) Exp. Advance Yes/No

Any advance taken from a place other than employees’ location of work. Please give details:
Amount taken Rs. from: Dt:

Purpose of said advance


Earlier Leave Encashment Status
Gratuity Receipt from Earlier Employer
PF / FPF Status:

Wish to withdraw Yes/No


Desired to transfer Yes/No

( Please fill form 13 for PF transfer, form 19 for PF withdrawal & form 10 C for FPF withdrawal)
Correspondence address and telephone no ( if any)
For remittance to be sent

Date:
Place:

___________________________ _______________ ____________________


Department Manager Signature HOD Employee’s Signature
SETTLEMENT CLEARANCE FORM

Name:
Emp. No.:
Department:
Relieving Date:

Please let us know if there is any material/amount due from him/her.

[Link]. Department Particulars Signature


1 Accounts

2 HRD

3 IT

4 Administration

Car

Laptop

Any other

5 Personnel

6 Marketing

7 Legal

10

Personnel Department
Date:

Employees’ Dues particulars to be included in Full & Final Settlement. (For Payroll Department)  TO BE FILLED BY T
(To be retained by Accounts Department) SETTLEMENT CLEARANCE ( to be filled by the Dept. Manager) Name of the emp
SETTLEMENT CLEARANCE FORM Name: Emp. No.: Department: Relieving Date: Please let

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