Escolar Documentos
Profissional Documentos
Cultura Documentos
7
Revised
Series of2018
2017
Agency Name
CLEARANCE FORM
(Instructions at the back)
I PURPOSE
Date of Filing
TO: (Agency Name)
I hereby request clearance from money, property and work-related accountabilities for:
Purpose: £ Transfer £ Resignation £ Other Mode of Separation:
£ Retirement £ Leave Please specify: __________________________
Date of Effectivity: __________________________________________________________
_______________________________ _______________________________
Immediate Supervisor Head of Office
III CLEARANCE FROM MONEY AND PROPERTY ACCOUNTABILITIES
Name of Unit/Office/Department Cleared Not Cleared Name of Clearing Officer/Official
1. Administrative Services
c. Agency-accredited Union/Cooperative
2. Library
b. Library Services
3. Finance and Assets Management
a. Financial Services
a. Scholarship Services
IV CERTIFICATION OF NO PENDING ADMINISTRATIVE CASE:
I hereby certify that this employee is cleared of work-related, money and property accountabilities from this agency. This
certification includes no pending administrative case from this agency.
_________________________________
Signature over Printed Name of Agency Head
Agency Name
ARANCE FORM
nstructions at the back)
Date of Filing
______________________________________
Name and Signature of Employee
_______________________________
Head of Office
Signature
elated, money and property accountabilities from this agency. This
om this agency.
_______________________
Printed Name of Agency Head
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INSTRUCTIONS:
2. This clearance should be duly accomplished before paying the last salary or
any money due the employees. (Specify which type of clearance: maternity
leave, retirement, transfer, etc.)
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