Clearance Form
Clearance Form
Clearance Form
DATE OF SEPARATION:
I certify that the aboved mentioned resigned member is cleared of all accountabilities.
I. CLIENT CLEARANCE
CLIENT AUTHORIZED SIGNATORY
ITEM OF CLEARANCE ACCOUNTABILITY NAME SIGNATURE DATE
(Pls. Print Name & Designation)
A. HR Department
B. Outlet Manager
C. Supervisors
2. SRF Department P
3. SRF OIC P
5. C- Load Department P
6. HR Department P
7. Operations Department P
8. Billing Department P
I hereby authorized Moses Cooperative to deduct from my separation pay all my financial
accountabilities to the cooperative.
_________________________________
Last Pay : (Member Signature over Printed name)
LAST SALARY ______________
VL/SL ______________
Less Deductions:
_________________________
CA ______________ Moses Human Resources Dept.
UNIFORMS ______________
OTHERS ______________
______________
NET PAY :