SAI CONSULTING ENGINEERS PVT. LTD.

CLEARANCE FORM
Name: Location: ...................
Emp. No.: Date of Joining: .........
Designation: Date of Resignation:
Department: Last Working Date:.....
To be filled by the Respective Department Representatives
Department Please Encircle Remarks Signature /
as applicable
I. Department of the Employees: Date
a. Retrieval of Office Documents YES / NO / NA
b. Reports YES / NO / NA
c. Table Keys YES / NO / NA
d. Stationery Items YES / NO / NA
II. IT:
a. Desktop / Laptop YES / NO / NA
b. Email-ID Deactivated YES / NO / NA
c. Timecard Submitted (iBMS) YES / NO / NA
III. Local Administration (If Applicable):
a. Company’s Accommodation YES / NO / NA
b. Any Other Assets YES / NO / NA
IV. Office Administration:
a. SIM Card Deactivated YES / NO / NA
b. Recovery if any YES / NO / NA
V. Accounts:
a. Advances / Security Deposit YES / NO / NA
b. Loans (If any) YES / NO / NA
VI. HR Department
a. Library YES / NO / NA
b. Exit Interview Form YES / NO / NA
c. ID – CARD Deposited YES / NO / NA
VII. Any other details (Please specify)

I have handed over charge of my duties to Mr/Ms.....................................................................as on

(DD/MM/YYYY)
I, Mr. / Ms..................................................................Emp. No. ........................... confirm that I have taken charge
from Mr./Ms. .................................................................

(Signature of Employee) (Signature of Charge Taken by) (Signature of Dept. Head)

I agree to keep secret and confidential any and every document or any other information relating to any
Process / Projects / Proposals which I have received or come across during the course of my association
with SAI Consulting Engineers Pvt. Ltd.
Permanent Address: Bank Details
Bank A/c. No.: .....................................................

...............................Pin Code:
Contact No.: ...............................................
Email:
Branch:.
Bank Name:.........................................................
Address:.............................................................
PAN No.: .............................................................
(Signature of Employee) (Signature of HR)