No Dues Form (Version Release Date :: Nov 2016)

Employee Details

Date:

Employee Code:

Designation:

Employee Name:

Division/ Department:

Date of Joining:

Store Name/ Location:

Offical E-Mail ID:

Date of Resignation (DOR):

Personal Mail ID(for exp. letter):

Last Working Day (LWD):

Present Address of the Employee

Mobile:
Get clearance from the respecitve functions:
1 Immediate Reporting Manager

Next Level Reporting Manager

Uniform (Where Applicable)

(Not required for TMs/CSAs/GREs and

Uniform returned: (Yes / No)

Equivalent Employees at Store Level)

If No, Uniform Recovery Amount

Date & Signature:

Date & Signature:

Date, Signature and Stamp:

Name & Designation:

Name & Designation:

Name & Designation:

If e-mail ID forwarding required, mention ID

2 Administraton
ID Card:
Access Card/ AEP & Biometric Pass(wherever applicable):
SIM Card:
Outstanding Mobile Bill Amount (If exceeding the limit):
Mobile set or any other asset issued, if any:

Date & Signature:

Data Card, if any:

Name & Designation:

3 Training Department, as applicable

Training modules returned/ CDs:

Date & Signature:

Any other recoverable:

Name & Designation:

4 Finance & Accounts (Corporate Finance Desk or In Co-ordination with the Corporate Finance Desk, Corp Desk will be Final)
Imprest, if any:
Advance, if any:
Reimbursement (Dr/Cr), if any:

Date & Signature:

Any other recoverable/ payable:

Name & Designation:

5 IT Department (Not applicable for Store Level employees)

Laptop returned, if any:
Laptop bag returned, if any:
Laptop charger returned, if any:
Any other asset issued(Harddisk, pen drive, camera etc.), if any:
De-Activation of E-mail ID, if applicable:
Forwarding of E-mail ID & Change of Password, if applicable:
De-Activation of HRIS User ID, if applicable:

Date & Signature:

Any deduction towards damage/ loss

(mention amount):

Name & Designation:

6 No Dues Receipt Details (For Payroll Team Purpose Only)

Exit Documents Received on:
Signature:

7 Leaving Employee Section

Have read & acknowledge all the above sections
and request to process my Full & Final

No Dues Completion Date:

Signature:

Employee Signature with Date

Note: Point Number (2 to 5) are not applicable for Team Members/CSA/GRE/ & Equivalent employees at Store level.
Note: In case of e-mail ID forwarding, it is mandatory to change the password by Team IT.
Note : Cancelled Cheque to be attached along with the completed No Dues Form for F & F Payment Through RTGS/NEFT.