Employees’ Dues particulars to be included in Full & Final Settlement.
(For Payroll Department)
TO BE FILLED BY THE EMPLOYEE
I Mr. _________________ Location_______________) have resigned from the
services of the company as on date _________________ and being relieved
from the Company W.E.F. dated _____________. I have non 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
____________
Signed By Emp. Verified By Supervisor
Dept.
Desig.
Signature by HOD.
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 Doc’s Nos. Signature of a person to whom charge given
1.
2.
3.
4.
Company’s Property Possession Person’s signature to whom handed over :
ID Card Yes/No
Mobile & SIM Yes/No
IT Assets Yes/No
System Password Yes/No
Files passwords Yes/No
Vehicle Yes/No
Advance Status:
Personal Loan Yes/No
Salary Advance Yes/No
Any advance taken from a place other than employees’ location of work. Please give details:
Amount taken Rs. ____________from: _______________Date:______________
Employee Signature Signature HOD
Date:
Place:
NO DUES 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 Administration
3 HR
4 IT
Laptop
Computer
Assets
Date:……………………. Admin Department
