Employee Clearance Form

Instructions:
1. Section 1 : To be completed by employee.
2. Section 2 : Employee will need to complete his/her clearance at all departments on his/her last physical work da
ensure that employee returns all company assets and outstanding matters cleared before signing off.
3. Employee is to return the completed clearance form for final clearance.
4. Last payment will be released to the employee upon the completion (signed off by all departments) of the cleara

Section 1: Personal Data

Employee ID Leave Period (if any)

Employee Name Physical Last Day

Designation Last Date of Service

Line Manager Name

Mailing Address
Country

Contact No Personal Email Address

Section 2 : Department Clearance

Clearance Item Clearance Status Remarks

Laptop / Desktop including
data cable
LCD / Docking Station /
Screen Filter

Computer Lock

Company Mobile Phone

Cisco IP Phone including

data cable

Cisco IP Phone Headset

Intercall / WebEx Account

Live Meeting / OCS
Account

Juniper VPN Account

Business Applications
include IA Store/ GSP/ Sale
Funnel / E-procurement / E-
stationary / DHL / UPS /
Web Timesheet.

Others, pls specify

 l departments on his/her last physical work day. Department Representatives need to
matters cleared before signing off.
ance.
on (signed off by all departments) of the clearance form.

ection 1: Personal Data

n 2 : Department Clearance

Department Representative Sign Off

(Signatory, Name & Date)
Employee Clearance Form

Instructions:
1. Section 1 : To be completed by employee.
2. Section 2 : Employee will need to complete his/her clearance at all departments on his/her last physical work da
ensure that employee returns all company assets and outstanding matters cleared before signing off.
3. Employee is to return the completed clearance form for final clearance.
4. Last payment will be released to the employee upon the completion (signed off by all departments) of the cleara

FINANCE

Clearance Item Clearance Status Remarks

Loans / Advances

Expense Claims

AMEX Online Statement

Others, pls specify

Facilities Management

Clearance Item Clearance Status Remarks

Keys Issued (Rooms /
Cabinets / Pedestals)

Access Cards

Outstanding Payments

Others, pls specify :

 l departments on his/her last physical work day. Department Representatives need to
matters cleared before signing off.
ance.
on (signed off by all departments) of the clearance form.

Department Representative Sign Off

(Signatory, Name & Date)

Department Representative Sign Off

(Signatory, Name & Date)
Employee Clearance Form

Instructions:
1. Section 1 : To be completed by employee.
2. Section 2 : Employee will need to complete his/her clearance at all departments on his/her last physical work da
ensure that employee returns all company assets and outstanding matters cleared before signing off.
3. Employee is to return the completed clearance form for final clearance.
4. Last payment will be released to the employee upon the completion (signed off by all departments) of the cleara

Real Estate

Clearance Item Clearance Status Remarks

Apartment Keys
Clearance done at
apartment/s

Outstanding Payments

Others, pls specify :

DEPARTMENT (Main Representative: Reporting Manager or Department Administrator)

Clearance Item Clearance Status Remarks

Keys Issued by Department
(if any)

Manuals / Files
Company's CDs & Project
related software
Price Book / Project
Literature
Reference books /
Magazines / Brochures

Stationery

Working Tools & Equipment

Safety Shoes & Overall

Others, pls specify :

HR

Clearance Item Clearance Status Remarks

Training / Tuition Loan

Car Key / Petrol Card

AMEX Card
 l departments on his/her last physical work day. Department Representatives need to
matters cleared before signing off.
ance.
on (signed off by all departments) of the clearance form.

Department Representative Sign Off

(Signatory, Name & Date)

or)

Department Representative Sign Off

(Signatory, Name & Date)

Department Representative Sign Off

(Signatory, Name & Date)
Employee Clearance Form

Instructions:
1. Section 1 : To be completed by employee.
2. Section 2 : Employee will need to complete his/her clearance at all departments on his/her last physical work da
ensure that employee returns all company assets and outstanding matters cleared before signing off.
3. Employee is to return the completed clearance form for final clearance.
4. Last payment will be released to the employee upon the completion (signed off by all departments) of the cleara

Corporate Health Services

Card (PanGroup)
Termination of HRIS
accounts
Termination of Insurance
Coverage & Flex Account
Employment / Work Permit
Pass

Income Tax Clearance

Others, pls specify :

NOTE: For Manuals/Files/CDs/Software/Price Book/Literature, please attach a separate list with details w
DECLARATION BY EMPLOYEE : This is to certify that I do not have in my possession any Invensys prop

Signed Off By Employee Signed Off by HR Representative

Name Name

Date Date
 l departments on his/her last physical work day. Department Representatives need to
matters cleared before signing off.
ance.
on (signed off by all departments) of the clearance form.

please attach a separate list with details where applicable.

have in my possession any Invensys property.