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EXIT CLEARANCE FORM

Name & Employee Id


:
VINAY SHARMA
Designation
:
TEACHING FELLOW
Department
:
ECONOMICS
Resignation Date
:
Last Working Day/contract End Date:
:

Persons in-charge are required to sign-off in the respective sections mentioned below. Processing of full & final
settlement will be initiated, after all the clearances.

REPORTING MANAGER/ STATUS Name & Signature of Authorized


I.
DEPARTMENTAL HEAD CLEARANCE (Yes/ No) Person
Handover of all documents given and report
1. submitted.

Work responsibilities completed


2.
Email id (to be retained/ deleted), in case of
3. retained, period to be specified.

Any other (Absconding, notice period waiver


4.
etc.)

STATUS Name & Signature of Authorized


II. IT CLEARANCE
(Yes/ No) Person
Desktop/ Laptop handed over
1.
Laptop Bag handed over
2.
External Hard Device (if any) handed over.
3.
Any other equipment from IT handed over
4.

5. Data Handover to (if any)

6. ERP Access

STATUS Name & Signature of Authorized


III. FINANCE CLEARANCE
(Yes/ No) Person
Any imprest amount pending
1.
Any salary advance pending
2.
Any other recovery pending
3.

STATUS Name & Signature of Authorized


IV. LIBRARY CLEARANCE
(Yes/ No) Person
1. Book Dues

STATUS Name & Signature of Authorized


V. HR CLEARANCE
(Yes/ No) Person
Resignation intimation received
1. (in hard/ soft form)
Insurance Card & ID card
2.

3. Resignation acceptance received


INFRASTRUCTURE/ ADMIN STATUS Name & Signature of Authorized
VI.
CLEARANCE (Yes/ No) Person
Office/ Work Station handed over
1.
Flat handed over within campus if applicable :
-
(a) Electric unit billing due _________Units.
2.
(b) Rent due Rs__________
(c) Any other due ___________

Flat handed over in Parker if applicable : -


(a) Electric unit billing due
__________units.
3. (b) Rent due Rs __________.
(c) Wi/Fi billing due Rs __________.
(d) Any other dues ____________.

STATUS Name & Signature of Authorized


VII. ADMIN CLEARANCE
(Yes/ No) Person
1. Mobile Handset / Sim card / Data card

2. Infirmary Payment

3. Transport Payment

4. Laundry Payment

5. Other

TO BE FILLED BY EMPLOYEE

Regarding my full & final settlement payment:-

I agree that in the event of non-submission of investment proofs, income tax will be deducted in the full & final
settlement, as per Income Tax rules.

I hereby authorize _____________________________ to collect my dues or Organization may deposit the


cheque in my bank, details of which are mentioned below. Also Experience Letter may kindly be couriered to the
below mentioned communication details.

Bank Name & Branch

Account Number

IFSC Code

Branch Address
Address for Communication

Email id

Alternate Email id

Contact Number

Alternate Contact Number

Employees Signature Date:

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