Form No: 06-01-HR-F018

Issue No:01

Dhaka, Bangladesh.

Employee Exit Clearance Form

Employee Name: Designation: Department: Name of Sales Centre:
(only applicable for Sales & Depot personnel)

Employee ID : Salary Grade: Division: Base Town:

(only applicable for sales personnel & SPR)

Date of Joining: Resignation Submission Date: Type of Employment: Confirmed

Mobile Number: Resignation Effective Date: Probation Casual Cotractual/Temporay

Reason of Separation:

Personal Ground

Others (Please specify)

The following checklist is provided to assist employee and department with the exit process. If required, also deactivate item. Kindly where task is completed and N/A when applicable.

= Task Completed

N/A = Not Applicable

Clearance from Concerned Division (

Please tick

Receiving initial with ID

Files & Company Documents Desk/Locker/Shelf/Keys/Uniform Others (please state ) Store related stationeries, uniform/apron Charge handover Signature with ID of Line Manager/Divisional Head: Date:

Clearance from IT Division

Please tick

Receiving initial with ID

PC (Full set) /Laptop/Printer/Scanner/Pen Drive: Other accessories (if required, please specify): Signature of Head of IT: Date:

MR/15.06.2011

Page 1 of 6

Form No: 06-01-HR-F018

Issue No:01

Dhaka, Bangladesh.

Employee Exit Clearance Form

Applicable for Marketing Sales Personnel & SPR only Marketing total outstanding (taka): Motorcycle, Key & related documents: Signature of incumbent : As on: Sig. of Depot/concerned In-charge: Signature Line Manager :

Signature of RSM/ASM/DSM/MM: Clearance from Accounts & Finance Division Advance Settled (if any) Outstanding Official Mobile Bill till last date of notice.
Salary adjustment (due to Shortfall of Notice Period)

Please tick

Receiving initial with ID

Others (please state ) Signature with ID of Line Manager/Divisional Head: Date:

Clearance from Human Resources Division Exit Interview (done ) SIM Card [Mobile (returned/deactivated) & Mobile Set returned (if applicble) Mobile Number: Access/ID Card (returned ) Company Car & related document (Returned ) Others (please state )

Please tick

Receiving initial with ID

I hereby accept responsibility for all the properties / benefits assigned to me during my employment. Upon my separation, in order to leave The ACME Laboratories Ltd. in good standing and to clear all obligations, I agree that ACME has the authority to collect or deduct during my exit procedure or from my final settlement any unpaid amounts for properties which are not returned, any overpayment of salary, amounts due to the shortage of notice period or any other unpaid debts to the company.

Employee's Signature & Date HR Comments / Remarks (if any)

Sig. of HR Manager/ HR Representative

Sig. Head of HR

MR/15.06.2011

Page 2 of 6

Form No:

aSpecilized Pharmaceuticals Ltd

Corporate Office, Dhaka

Issue No:1

Employee Exit Clearance Form

Employee Name: Designation: Department: Name of Sales Centre:
(only applicable for sales & Depot personnel)

Employee ID : Salary Grade: Division: Base Town:

(only applicable for sales personnel & SPR)

Date of Joining: Resignation submission Date: Type of Employment: Confirmed

Mobile Number: Resignation Effective Date: Probation Casual Cotractual/Temporay

Reason of Separation:

Personal Ground

Others (Please specify)

The following checklist is provided to assist employee and department with the exit process. If required, also deactivate item. Kindly where task is completed and N/A when applicable.

= Task Completed

N/A = Not Applicable

Clearance from Concerned Division (

Please tick

Receiving initial with ID

Files & Company Documents Desk/Locker/Safe/Keys/Uniform Others (please state ) Store related stationeries Charge handover Signature with ID of Line Manager/Divisional Head: Date:

Clearance from IT Division

Please tick

Receiving initial with ID

PC (Full set) /Lap Top/Printer/Scanner/Pen Drive: Other accessories (if required, please specify): Signature of Head of IT: Date:

MR/HR/.....

Form No:

Employee Exit Clearance Form

Issue No:1

Applicable for Marketing Sales Personnel & SPR only Marketing total outstanding (taka): Motorcycle, Key & related documents: Signature of incumbent : As on: Sig. of Depot/concerned In-charge: Signature Line Manager :

Signature of RSM/ASM/DSM/MM: Clearance from Accounts & Finance Division Advance Settled (if any) Outstanding Official Mobile Bill till last date of notice.
Salary adjustment (due to Shortfall of Notice Period)

Signature of HOD: Please tick Receiving initial with ID

Others (please state ) Signature with ID of Line Manager/Divisional Head: Date:

Clearance from Human Resources Division(CO/Plant) Exit Interview (done ) SIM Card [Mobile (returned/deactivated) & Mobile Set returned (if applicble) Mobile Number: Access/ID Card (returned ) Company Car & related document (Returned ) Store related stationeries, uniform/apron Others (please state )

Please tick

Receiving initial with ID

I hereby accept responsibility for all the properties / benefits assigned to me during my employment. Upon my separation, in order to leave

The ACME Laboratories Ltd. in good standing and to clear all obligations, I agree that ACME has the authority to co

Employee's Signature & Date HR Comments / Remarks (if any)

Sig. of HR Manager/ HR Representative

Sig. Head of HR

MR/HR/.....

Form No:

aAgrovet & Beverage Ltd.

Corporate Office, Dhaka

Issue No:1

Employee Exit Clearance Form

Employee Name: Designation: Department: Name of Sales Centre:
(only applicable for Sales & Depot personnel)

Employee ID : Salary Grade: Division: Base Town:

(only applicable for sales personnel & SPR)

Date of Joining: Resignation submission Date: Type of Employment: Confirmed

Mobile Number: Resignation Effective Date: Probation Casual Cotractual/Temporay

Reason of Separation:

Personal Ground

Others (Please specify)

The following checklist is provided to assist employee and department with the exit process. If required, also deactivate item. Kindly where task is completed and N/A when applicable.

= Task Completed

N/A = Not Applicable

Clearance from Concerned Division (

Please tick

Receiving initial with ID

Files & Company Documents Desk/Locker/Shelf/Keys/Uniform Others (please state ) Store related stationeries, uniform/apron Charge handover Signature with ID of Line Manager/Divisional Head: Date:

Clearance from IT Division

Please tick

Receiving initial with ID

PC (Full set) /Lap Top/Printer/Scanner/Pen Drive: Other accessories (if required, please specify): Signature of Head of IT: Date:

MR/HR/.....

Form No:

Employee Exit Clearance Form

Issue No:1

Applicable for Marketing Sales Personnel & SPR only Marketing total outstanding (taka): Motorcycle, Key & related documents: Signature of incumbent : As on: Sig. of Depot/concerned In-charge: Signature Line Manager :

Signature of RSM/ASM/DSM/MM: Clearance from Accounts & Finance Division Advance Settled (if any) Outstanding Official Mobile Bill till last date of notice.
Salary adjustment (due to Shortfall of Notice Period)

Signature of HOD: Please tick Receiving initial with ID

Others (please state ) Signature with ID of Line Manager/Divisional Head: Date:

Clearance from Human Resources Division(CO/Plant) Exit Interview (done ) SIM Card [Mobile (returned/deactivated) & Mobile Set returned (if applicble) Mobile Number: Access/ID Card (returned ) Company Car & related document (Returned ) Others (please state )

Please tick

Receiving initial with ID

I hereby accept responsibility for all the properties / benefits assigned to me during my employment. Upon my separation, in order to leave

The ACME Laboratories Ltd. in good standing and to clear all obligations, I agree that ACME has the authority to co

Employee's Signature & Date HR Comments / Remarks (if any)

Sig. of HR Manager/ HR Representative

Sig. Head of HR

MR/HR/.....