No Due Clearance Form
Employee Name Department
Employee Code Project
Date of Joining Reporting Manager
Employee Details for Future Correspondence:
Contact Number Email ID
Permanent Address
Exit Type (To be filled by Project Head / RM)
Resignation / Termination Reason
Resignation / Termination Date Last Working Date
SECTION 1 (Project SPOC: Project Head / Regional Manager / SDM)
Particulars Status Remarks (if any)
a) Resignation Letter / Bank statement / Cancelled Cheque (stating employee
name as per bank) Submitted by Employee and Copy Enclosed
b) Notice Period Served by Employee
No of Days for Notice Period Not Served by Employee
c) ID Card Returned by Employee
d) Mobile SIM / Data Card Issued to Employee
Whether SIM Transferred to another
If Yes
Employee:
SIM Transferred to: Employee Name & Code
SIM Card Number
If Transferred to another employee
Data Card Number
SIM Transfer Details informed to Admin
Team
Asset Return Form Telecom Asset Return Form submitted
e) Any Conveyence Amount Due for Employee
If Yes Claim Month :
Amount :
Pending Details informed to Accounts
e) Any Incentive Amount Due for Employee
If Yes Claim Month :
Amount :
Pending Details informed to HR
If Yes HR SPOC Name & Date
e) Any Other Amount Due for Employee
If Yes Claim Month :
Amount :
Pending Details informed to Accounts
SPOC
If Yes Accounts SPOC Name & Date
f) Tool Kit Issued to Employee
If Yes Tool Kit Returned by Employee
g) Laptop / Desktop Issued to Employee
If Yes Laptop / Desktop
Returned by Employee
"IT Asset Return Form" submitted
h) Any Recovery from Employee
If Yes Details (supporting document required):
Amount of Recovery:
i) Email ID issued to Employee
If Yes Email ID Issued
Status
Confirmation from IT
j) Any Other Asset Issued to Employee
If Yes Asset Details:
Returned by Employee
Name Signature Date
Employee
Reporting Manager
Project SPOC: Project Head / Regional
Manager / SDM
SECTION 2 (Logistics Dept)
Particulars Status Remarks (if any)
a) Any Asset Issued to Employee
If Yes Asset Details:
Returned by Employee
Name Signature Date
Logistic SPOC
SECTION 3 (Accounts)
Particulars Status Remarks (if any)
a) Details of Conveyance / Incentive mentioned in Section 1 are Correct
If No, mention the details
b) Any Imprest / Loan Amount Due for Employee
IF Yes :
Imprest Amount :
Respective Month for Imprest
Kindly specify Details of Imprest
Name Signature Date
Accounts SPOC
SECTION 4 (Human Resources)
Particulars Status Remarks (if any)
a) Section 1 Completed & signed by Employee, Reporting Manager, and Project
SPOC: Project Head / Regional Manager / SDM
b) Section 2 Completed & signed by Accounts
c) Gratuity Applicable
d) Leave Encashment (EL)
If Yes Number of encashable leaves:
e) Notice Period Served by Employee
If NO shortfall days of Notice Period
f) Salary Payable with F&F From (Date): To (Date) :
Name Signature Date
HR SPOC
Form No. : AFS/HR/17 Revision No. : 01 Release Date: 11 December 2017
