Resignation form for Employee

1 Name of the Employee
2 Designation
3 Department/Section
4 Place of posting
5 Date of joining in service
6 Date of leaving the service
7 Mode of leaving (Resignation/Retirement /Termination)
8 In case of resignation, has the employee submitted prior notice as stipulated, if not give recommendations for recovery of amount for notice period


1 Salary Payable (From the date of last salary drawn to the date of resignation)
2 Security deposit held if any
3 Balance of Privilege leave, if any
4 Bonus payable
5 Statutory retirement benefits
6 Is the employee eligible for Gratuity, if so amount payable

Place: Signature:

(for Office Use Only)

All the sectional heads are requested to give NOC for relieving the concerned employee. Before issue please check, if any dues against the employee.

  Manager (Admin)

  1. Concerned Employe
  2. Clerk Estt.
  3. Store Clerk
  4. Acctt. Deptt.

C.E.O. Manager (Admin)

Relieved Mr._______ (Name)________on___________.All his/her dues as mentioned on back page may be paid.

  Manager (Admin)

Manager (Accounts) 

Paid vide cheque no._______________dated________drawn on_____________________ after obtaining No Dues Certificate from the employee concerned.

Manager (Admin)Manager (Accounts)

O.A (Estt.)