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AHG Exit No Dues Clearance Form 2

This document is an exit clearance form completed by the employee and various departments to reconcile assets, documents, equipment, and financials. It includes sections for the employee's employment details, contact information, assets handover, IT equipment return, administrative items return, human capital items return, exit process checklist, and payroll clearance. Departments must indicate the status of returning each item and sign after taking possession. The final page requires signatures from the employee and functional head to approve the exit, and the human capital manager to finalize the exit clearance.

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Nikita Jaiswal
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462 views3 pages

AHG Exit No Dues Clearance Form 2

This document is an exit clearance form completed by the employee and various departments to reconcile assets, documents, equipment, and financials. It includes sections for the employee's employment details, contact information, assets handover, IT equipment return, administrative items return, human capital items return, exit process checklist, and payroll clearance. Departments must indicate the status of returning each item and sign after taking possession. The final page requires signatures from the employee and functional head to approve the exit, and the human capital manager to finalize the exit clearance.

Uploaded by

Nikita Jaiswal
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
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Exit No Dues Clearance Form

Employment Details - Completed by employee


Employee Name Title. First Name + Middle Name + Surname
Employee Code Designation
Employment Type Cost Centre
Reporting Manager Name Department
Subsidiary Name Location
Termination Date Last working Date
Contact Details - For Future correspondence
Contact Number 1 Contact Number 2
Personal Email ID
Residential Address Permanent address

Pincode State Country Pincode State Country

Assets Handover - Completed by related departmental authorities with signatures


Department Inventory Status Comments Hand over taken by
Files/ Manuals/Handbooks Yes/No/NA
Own Other Documents Yes/No/NA Name & Signature
Any other (specify below) Yes/No/NA

Email ID & User ID Deactivation Yes/No/NA


Information Desktop / Laptop Yes/No/NA
Technology Data Modems Yes/No/NA Name & Signature
(IT) Data back-up tools Yes/No/NA
Any other (specify below) Yes/No/NA

F/AHG/HC/008/REV-0/2017 Page 1 of 2
Exit No Dues Clearance Form

Mobile Handset & Sim Card Yes/No/NA


Stationary Yes/No/NA
Cabinet & Drawer Keys Yes/No/NA
Admin Name & Signature
Travel Advance Yes/No/NA
Parking Bay Yes/No/NA
Any other (specify below) Yes/No/NA

Imprest Account (Specified


Yes/No/NA
losses)
Human Company Leased Accommodation Yes/No/NA
Capital Name & Signature
Employee ID Card/Punching Card Yes/No/NA
(HC)
Visiting Cards Yes/No/NA
Any other (specify below) Yes/No/NA

Checklist – Completed by HC Team


Topics Status Date
Exit notice received (Resign/termination/retirement letter copy) Yes / No / NA DD / MM / YY
PF withdrawal form sent to employee Yes / No / NA DD / MM / YY
Personnel manual Yes / No / NA DD / MM / YY
Exit interview conducted with exit form Yes / No / NA DD / MM / YY
IT Ticket logged by Yes / No / NA DD / MM / YY

Payroll Clearance – Completed By Payroll Team


Components Status Details Amount Data furnished by
Dues on account of salary Yes / No / NA
Any other discretionary remuneration Yes / No / NA Payroll Administrator
No. of paid leave to be en-cashed Yes / No / NA
Name & Signature
Other Yes / No / NA
Other Yes / No / NA
Deductions
Salary in advance Yes / No / NA
Notice pay buy out Yes / No / NA
No of days of notice period to be recovered Yes / No / NA
Telephone / mobile bill/cost deduction Yes / No / NA
Retention bonus
Employee Loan Yes / No / NA
Study Loan /Agreement Yes / No / NA
Other outstanding fees Yes / No / NA
Bonds / undertakings Yes / No / NA
Salary paid up to (date): Yes / No / NA

F/AHG/HC/008/REV-0/2017 Page 2 of 2
Exit No Dues Clearance Form

For Employee -
Name Signature Date DD / MM/ YY

Comments By HOD
Functional Head

Name Signature Date DD / MM/ YY

Human Capital Manager

Name Signature Date DD / MM/ YY

F/AHG/HC/008/REV-0/2017 Page 3 of 2

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