CLEARANCE FORM

EMPLOYEE DETAILS
Name (print or type)
PF Number
Department
Effective date of leaving (dd/mm/yyyy)

Please obtain clearance signatures from appropriate offices as indicated below

SECTION (A): ADMINISTRATION SECTION:

ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Office Cleared
Print Name
Office Keys

Locker Keys Signature

Vehicle (include all keys, tool box, spare
wheels and triangles)
Date (dd/mm/yyyy)
Fuel Card

SECTION (B): HUMAN RESOURCE SECTION:

ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Employment ID
Print Name
Medical one stop card for self Y spouse

Door card Signature

Date (dd/mm/yyyy)

SECTION (C): INFORMATION TECHNOLOGY SECTION:

ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Computer access cancelled

Print Name
Computer/Laptop equipment(s)

Printer(s) Signature
Access control

Camera/Phone Date (dd/mm/yyyy)

I certify that the information above is accurate

Employee Signature Date (dd/mm/yyyy)

Clearance form v1.1.2015
SECTION (D): FINANCE DEPARTMENT
ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Signature authority cancelled

Print Name
Petty cash float (expense report or
refund)
Signature

Date (dd/mm/yyyy)

SECTION (E): SALES DEPARTMENT

ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Clearance from distributors

Print Name

Signature

Date (dd/mm/yyyy)

SECTION (F): MARKETING DEPARTMENT

ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Samples, catalogues, manuals

Print Name

Signature

Date (dd/mm/yyyy)

SECTION (G): SUPPLY CHAIN

ITEMS TO CLEAR (check against each item) Print Name & Sign (approved)

Assigned goods clearance

Print Name
Other Reconciliation

Signature

Date (dd/mm/yyyy)

I certify that the information above is accurate

Employee Signature Date (dd/mm/yyyy)

Clearance form v1.1.2015