Government Official Exit Clearance Form

Personal Information

Full Name Position/Designation Department/Agency Employee ID/Number Last Working Day

Clearance Checklist

Office/Department	Clearance Status	Remarks	Authorized Signatory
Human Resources
Finance
IT/Assets
Records/Archives
Other

Employee Declaration

I hereby declare that I have returned all government property and settled all my obligations.

Employee Signature Date

Certifications

HR/Authorized Officer Signature Date