Residency Exit Clearance Form
Resident Information
Name
Resident ID
Room/Unit No.
Date of Entry
Date of Exit
Contact Information
Clearance Checklist
Item/Area
Status
Remarks
Room Keys Returned
Yes
No
Furniture & Equipment
Good
Damaged
Lost
Utilities Cleared
Yes
No
Bills Settled
Yes
No
Other (Specify)
Yes
No
Notes / Comments
Cleared By
Signature
Date