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Clearance Form

The document is a form from Swal Corporation Ltd regarding an employee's final settlement details upon resignation. It includes sections for the employee to provide their personal information and details of pending dues like salary, travel expenses, loans/advances, leave encashment, gratuity and other payments. The form is to be filled by the employee, department manager, and head of department. It also includes a settlement clearance form to note any outstanding materials or amounts due from the resigning employee across different departments before finalizing the settlement.

Uploaded by

Muhammad Rashed Nadeem
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161 views3 pages

Clearance Form

The document is a form from Swal Corporation Ltd regarding an employee's final settlement details upon resignation. It includes sections for the employee to provide their personal information and details of pending dues like salary, travel expenses, loans/advances, leave encashment, gratuity and other payments. The form is to be filled by the employee, department manager, and head of department. It also includes a settlement clearance form to note any outstanding materials or amounts due from the resigning employee across different departments before finalizing the settlement.

Uploaded by

Muhammad Rashed Nadeem
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Swal Corporation Ltd

Employees Dues particulars to be included in Full & Final Settlement.


( For Payroll Department)

TO BE FILLED BY THE EMPLOYEE

I Mr. __________________________________________ (Emp. No. ___________,


Location_______________ ) have resigned from the services of the company as on date
_________________ and being relieved from the Company w.e.f. dated _____________.

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) Travel Imprest / Advance / Loan with me Rs. _____________ to be deducted from my final settlement
dues.

4) Leave encashment for the _______ days credit to my account.

5) Gratuity Payment ( ______Yrs ________Month ______Days of service )

6) Leave Travel Concession from _________ to __________ for Rs. ___________ due to me not
claimed earlier ( Taxable / Non taxable )

7) Medical Reimbursement from ________ to ________ for Rs. ________________


( Medical Bills to be attached with the medical format)

8) Incentive Rs. _______________ eligible and payable for target achieved for the period ____________
HOD approved letter enclosed.

9) Other dues to be taken into account not specified in the list given above: ( Kindly give details of the
same)

10) Notice Pay Payment / Recovery _______ days / month.

11) Specify if authorized signatory of any company matter/ document Yes/ No ____________ Signature
by HOD ____________
12) Action taken by company on point no.11 to delete the same. Signature by HOD ____________

Signature of employee
Name: Name of Dept. Manager _________________

Address: Authorized by Dept. Manager ____________

Authorized by HOD: ___________________


Swal Corporation Ltd
( To be retained by HRD Department)

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

Companys Documents Nos. Signature of a person


to whom charge given
1)
2)
3)
4)
5)

Companys Property Possession Persons signature to


whom handed over (If yes, please give details)
1) House accommodation Yes/No
2) Vehicle Yes/No
3) Telephone Yes/No
4) Equipments Yes/No
5) Others Yes/No
6) Files pass words Yes/No
Advance Status:
1) Imprest Yes/No
2) Vehicle Loan Yes/No
3) Housing Loan Yes/No
4) Housing HDFC Loan Yes/No
5) Personal Loan Yes/No
6) Salary Advance Yes/No
7) Exp. Advance Yes/No

Any advance taken from a place other than employees location of work. Please give details: Amount
taken Rs. from: Dt:

Purpose of said advance


Earlier Leave Encashment Status
Gratuity Receipt from Earlier Employer
PF / FPF Status:

Wish to withdraw Yes/No


Desired to transfer Yes/No

( Please fill form 13 for PF transfer, form 19 for PF withdrawal & form 10 C for FPF withdrawal)
Correspondence address and telephone no ( if any)
For remittance to be sent

Date:
Place:

___________________________ _______________ ____________________


Department Manager Signature HOD Employees Signature
Swal Corporation Ltd
SETTLEMENT CLEARANCE FORM

Name:
Emp. No.:
Department:
Relieving Date:

Please let us know if there is any material/amount due from him/her.

S.No. Department Particulars Signature


1 Accounts

2 HRD

3 IT

4 Administration

Car

Laptop

Any other

5 Personnel

6 Marketing

7 Legal

10

Personnel Department
Date:

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