FULL AND FINAL SETTLEMENT APPLICATION FORM
Employee Details
Name of the Employee:
Employee ID (If allotted):
Designation:
Department:
Date of Joining:	Last Working Day
Reason for Leaving:
Details of Pending Dues (if applicable):
Unpaid Salary (mention months):	TO	FROM
Leave Encashment (If Any)
Bonuses/Incentives (If Any)
Gratuity (if eligible)
Reimbursements (e.g., travel, office expenses) :(If Any)
Other (please specify):
Organizational Property Clearance:
ID Card Returned
Company Assets (e.g., laptop, phone) Returned
Office Documents/Materials Returned
Bank Account Details for Settlement Transfer:
Bank Name:
Account Number
IFSC Code:
Self-Declaration by Employee: I hereby confirm that the information provided above is accurate and that I have returned all Organizational property entrusted to me. I request the processing of my Full and Final Settlement. Employee Signature Date
For Office Use Only:
HR Department Clearance:
Name:
Signature:
Date
Finance Department Clearance:
Name:
Signature
Date
Settlement Processed By:
Final Amount Paid:	₹
Note	The consideration amount will be paid through cheque only with in 7 working days of submission of Dully Filled Application