Employee Clearance Form template

Employee Clearance Form Template Compliant with the Laws of the Kingdom of Saudi Arabia

Organisation: ........................, Commercial Registration No.: ............, Branch: ............ Employee: Mr/Ms ........................, National ID/Iqama No.: ............, Employee No.: ............, Department: ............, Job title: ............ Start date: / / AH    Last working day: / / AH Reason for end of employment: (resignation / expiry of contract term / termination by the employer / mutual agreement)

First: Handover of Custody Items

Department	Items to be cleared	Status	Responsible person’s name and signature	Date
Line management	Ongoing tasks and files	Done / Not done	....	....
Information technology	Computer, mobile phone, accounts, access rights	Done / Not done	....	....
Warehouse/custody items	Tools, uniform, keys, ID card	Done / Not done	....	....
Finance	Advances and cash custody	Done / Not done	....	....
Vehicles	Vehicle, its documents and traffic fines	Done / Not done	....	....
Human resources	Completion of statutory procedures	Done / Not done	....	....

Second: Financial Settlement (to be signed only after payment)

• Wages due up to the last working day: (............) Saudi riyals.
• Leave balance: (............) Saudi riyals.
• End-of-service benefit: (............) Saudi riyals.
• Other entitlements: (............)   Deductions (if any): (............)
• Net amount received: (............) Saudi riyals, paid on / / AH by (bank transfer / cheque).

Employee’s declaration: I declare that I have handed over everything in my custody according to the table above. And (I acknowledge receipt of all my entitlements set out above and have no claim against the organisation / I have not yet received my entitlements, and my signature on this clearance does not constitute a release from any statutory entitlement) — delete whichever does not apply. Employee: Name: ................ Signature: ................ Date: / / AH HR Manager: Name: ................ Signature: ................ Stamp: ................