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Clearance Form

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ACCOUNTABILITY CLEARANCE FOR THE RESIGNING MEMBERS

NAME: CLIENT: CPFI

POSITION : Merchandiser DATE STARTED:

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

II. COOP CLEARANCE (Submit to HR Department First)

C. FINANCIAL ACCOUNTABILITY FOR COOP HR DEPARTMENT USE ONLY

1. Accounting Department/ Last Payroll P

2. SRF Department P

3. SRF OIC P

4. Benefits Department / (VL/SL unused) 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 ______________

13th month pay ______________

SRF ______________ RECOMMENDING APPROVAL

VL/SL ______________

Less Deductions:
_________________________
CA ______________ Moses Human Resources Dept.

UNIFORMS ______________

CELL PHONE ______________


Cheque Release Date: ______________________
LAPTOP ______________ (By Operations Manager)

OTHERS ______________
______________
NET PAY :

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