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New Clearance Form

David Domingo worked as a CSR for Verizon Business from December 7, 2021 to July 25, 2022. He is clearing his accountabilities before his official separation date of July 29, 2022. The form details the items he must return, including his laptop, docking station, access badge, and company ID. It also addresses his SSS, Philhealth, and other government numbers, as well as compensation and benefits like his HMO card and any cash advances. Domingo acknowledges agreeing to have the value of any unreturned items deducted from his final pay, which will be processed within 45 working days after submitting his completed clearance form.

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david.domingo0305
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40 views1 page

New Clearance Form

David Domingo worked as a CSR for Verizon Business from December 7, 2021 to July 25, 2022. He is clearing his accountabilities before his official separation date of July 29, 2022. The form details the items he must return, including his laptop, docking station, access badge, and company ID. It also addresses his SSS, Philhealth, and other government numbers, as well as compensation and benefits like his HMO card and any cash advances. Domingo acknowledges agreeing to have the value of any unreturned items deducted from his final pay, which will be processed within 45 working days after submitting his completed clearance form.

Uploaded by

david.domingo0305
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CLEARANCE AND ACCOUNTABILITY FORM

NAME OF EMPLOYEE David L. Domingo EMPLOYEE ID


109030129
POSITION CSR DEPARTMENT/PROGRAM Verizon Business
DATE OF HIRE December 7, 2021 NAME OF SUPERVISOR Anne Macapagal / OM Julie Calderon

LAST DAY OF WORK July 25, 2022 DATE OF SEPARATION July 29, 2022

MOBILE NO. PERSONAL EMAIL [email protected]


09236507069

ACCOUNTABILITY NAME & SIGNATURE OF DATE


DEPARTMENT DETAILS (Indicate if CLEAR or AMOUNT OF ACCOUNTABILITY or
N/A if not applicable) CLEARING OFFICER SIGNED

 Turnover of all tasks


MANAGER/TRAINER  Approve TAMS DTR until last day of work.
(Attach dispute form if any) IMMEDIATE MANAGER/TRAINER
 Laptop  Docking Station Executive Approval to waive missing items:
IT  Laptop Bag  RSA Token _______________________ ____________
 Others _______________ Signature over printed name Date IT
 Access Badge ____________
 Company ID ______________
 Headset ______________
 Masterlock ______________

ADMINISTRATION  Yjack Cord ______________


 USB Adapter ______________
 Speaker ______________
 Pedestal/Cabinet Keys ______________
 Others
____________ ______________ ADMINISTRATION

Exit Documents received


 YES
 NO
HR LABOR RELATIONS Payment of Liquidated  YES
Damages  NO
BTO Conversion Eligibility
 YES
 NO HR LABOR RELATIONS
Government #s  SSS
 Philhealth
HRIS  HDMF
 TIN
 Exit Interview Ref # ______________________ HRIS
Deduct SSS Loan Balance?  Yes
 No
If NO, is waiver from new
HR COMPENSATION & employer submitted?  Yes
BENEFITS Please attach waiver.  No
 HMO Card/s
BTO Conversion (# of hours) _____________________ hours COMPENSATION & BENEFITS
*For Managers & Up
Filed all liquidation for cash advance, petty cash
FINANCE fund and gift check.
 Yes  No FINANCE

EMPLOYEE CHECKLIST
 Filed all medical reimbursement following HR guidelines. Claims submitted after submission of clearance will no longer be accepted.
 Reviewed PDY/TAMS attendance until last day of work.
 Settled property accountabilities before the effective date of separation with the company.
I acknowledge agreement on the above identified accountabilities. Therefore, I hereby authorize Afni Philippines, Inc. to deduct the full amount of accountabilities stated herein from
my final pay. I further acknowledge that my final pay shall be processed within 45 working days from submission of completed clearance.

David L. Domingo
Conforme: Signature over Printed Name Date Submitted

ACKNOWLEDGEMENT RECEIPT FORM

Thank you for completing your clearance.


Name:
Date Complete:
Received by:
Expected Final Pay Release Date:
We will send an email notification coming from [email protected] to your personal email address within 45 working days from the submission of the
employee clearance form to the HR POC. The notification will include the instructions regarding the release of your final pay.
You can also send us an email to [email protected].

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