Annexure X1
Full and Final Settlement Form
Employee Name: ________________________Employee No.: ____________ Designation:
_______________
Department: _______________ Location: _________________ Reporting to:
__________________________
Human Resources: Date of Joining:
Date of Resignation:
Date of Relieving:
Notice period required: Yes No
Notice period served: Yes No
Notice pay waiver: Yes No
(If Yes, attach approval note)
Notice pay recovery: No. of Days ______________
Leave Balance: No. of Days ______________
Net payable / recovery: No. of Days ______________
Any other: ________________________
HR Manager/Head Name & Signature: ________________________
Employee’s Department Vendor payments & bills cleared: Yes No
Documents/Data Handover: Yes No
Name & Signature of Line Manager: ________________________
HOD Name & Signature: ________________________
Information Technology Return of all devices: SIM Yes No
Phone Yes No
Laptop Yes No
Passwords (Official Email/ Personal Yes No
Email ID used for Official purpose/
Desktop/ Online accounts for official
Purpose):
Return of Access Card: Yes No
Any other: ________________________
Name & Signature of IT Representative: ________________________
Administration Surrender of:
1) Company owned vehicle:
2) Keys:
3) Stationary
4) ID Card
5) Any other
Name & Signature of Admin Representative: _________________________
Signature of the Employee: ____________________________________ Date: ___________________
Future Correspondence Address: ____________________________________________________________
Contact Nos. (Tel./Mobile): ____________________________________________________________
The form needs to be taken to departments in the sequence it is formed. The form in the end needs to be
submitted to HR by outgoing employee. HR in turn will submit it to the accounts department for further
processing.
Finance (Accounts / Payroll) Medical: _________________________
Travel: _________________________
Imprest: _________________________
Any other: _________________________
Salary Advance: __________________________
Loan: __________________________
LTA: __________________________
Total to be paid / recovered from __________________________
the employee:
Name & Signature of Accounts Rep.: _____________________________
Guidelines for the Outgoing employee:
The resignation letter must be submitted to the Reporting Manager with a copy to HR Manager.
HOD and HR Head shall be the final approving authorities.
In case of resignation acceptance by the company, HR will issue a Resignation Acceptance Letter
mentioning the date of relieving well in advance soon after receiving the original resignation letter with
HOD’s and Head HR approval.
To enable the Company to issue you the Full and Final Settlement Cheque, you need to observe the
following guidelines.
o The F&F Settlement Form shall be issued to outgoing employee by the HR manager as soon as
Resignation Acceptance Letter is issued by HR (but not more than 4 weeks before the relieving day)
o Its outgoing employee’s personal responsibility to get this Full and Final Settlement Form duly
signed by all concerned before leaving the Company. Inability to do so will eventually lead to
inordinate delay in your clearance. In case the person leaves the company without getting the F&F
Settlement Form signed by the all concerned signatories, he/she still have to take the personal
responsibility of completing it through his/her own follow-ups from outside Encompass.
