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    25.no Dues 162

    Uploaded by

    komalnkish
    This document is a no dues certificate for an employee who is resigning from their position. [1] It requests confirmation that there are no outstanding dues owed by the employee in various department accounts. [2] It outlines potential payments owed to the employee like LTA, medical reimbursement, leave days, and leave encashment. [3] It provides details for calculating any gratuity owed and notes whether a gratuity claim form was received.

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    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd

    25.no Dues 162

    Uploaded by

    komalnkish
    910 views2 pages
    This document is a no dues certificate for an employee who is resigning from their position. [1] It requests confirmation that there are no outstanding dues owed by the employee in various department accounts. [2] It outlines potential payments owed to the employee like LTA, medical reimbursement, leave days, and leave encashment. [3] It provides details for calculating any gratuity owed and notes whether a gratuity claim form was received.

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    25.no_dues_162

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    This document is a no dues certificate for an employee who is resigning from their position. [1] It requests confirmation that there are no outstanding dues owed by the employee in various department accounts. [2] It outlines potential payments owed to the employee like LTA, medical reimbursement, leave days, and leave encashment. [3] It provides details for calculating any gratuity owed and notes whether a gratuity claim form was received.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    910 views2 pages

    25.no Dues 162

    Uploaded by

    komalnkish
    This document is a no dues certificate for an employee who is resigning from their position. [1] It requests confirmation that there are no outstanding dues owed by the employee in various department accounts. [2] It outlines potential payments owed to the employee like LTA, medical reimbursement, leave days, and leave encashment. [3] It provides details for calculating any gratuity owed and notes whether a gratuity claim form was received.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    Company name NO DUES CERTIFICATE PART “A”

    Mr./ Ms. ___________________________ EMP No_______ Designation :-______________


    Department:- _______________ has resigned from service of company and he /she will be
    relived from the services of company with effect from ____________. (after closing hours).
    Please indicate dues, if any in his / her name from your department to enable us to settle
    his /her final dues.

    Date : MANAGER HR & IR


    Department Dues if any(in Rs) Signature of HOD
    Concerned HOD
    General stores
    Accounts
    Security
    Safety/Environment
    Personnel & Admin
    (Canteen/I.-card/Housing)
    Society-Emp.
    Co-op. credit
    Technical library

    TIME OFFICE/PAYROLL PART “B”


    1 LTA payable / recovery Rs
    2 Medical reimbursement payable Rs
    3 No. of days payable during current month ___________days
    4 No. of days payable for last month _________ days
    5 Leave encashment(days) ___________days

    TIME - OFFICE

    HR SECTION PART “C”


    1 Gratuity payable, if any
    Date of Joining: ____________ Yes/No
    Dt of Leaving: _____________
    ____years____months__days

    Claim form in respect of Gratuity –Form “I” Received / Not received


    2 Notice pay Recovery , if any _______days

    3 Other deductions, if any

    MANAGER – HR & IR

    CONTD..2
    NO DUES CERTIFICATE / PAGE:2
    PART “D”
    (To be filled by an employee seeking separation or being relieved from the services of
    Company)
    I wish that following action is to be taken in respect of my-

    S No. Heads Details


    1 PF/FPF
    2 Gratuity
    3 Bonus
    4 Superannuation
    5 Address for
    correspondence

    6 Address for remittance of


    dues, if any

    I agree to reimburse or repay the total amount against my personal bills, if any the Company
    may receive that after I am relieved from the services of Company.

    Date :
    Place : SIGNATURE
    RECEIPT
    RECEIVED a sum of Rs …………………….(Rupees ……………..) from the Management
    of M/s ________________ Limited, Address- ________________ in full and final
    settlement/satisfaction of all my claims/demand for reinstatement or reemployment including
    earned wages, encashment of leave, notice pay, retrenchment compensation, bonus
    Gratuity and all other dues which could accrue during the employment with the company. I
    HEREBY DECLARE THAT I DO NOT HAVE ANY CLAIM WHATSOEVER AGAINST
    M/s INA Bearings Private Limited

    I SAY RECEIVED Rs……………… vide cheque No……………dated………………

    Drawn on Bank of ………………………..

    FULL NAME : SIGNATURE

    Date
    [ pl affix revenue stamp of Rs1/-]

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