ANNEXURE I
No Dues Form (Version Release Date :: May 2017)
Employee Details Date:
Employee Code: Designation:
Employee Name: Division/ Department:
Date of Joining: Store Name/ Location:
Offical E-Mail ID: Cancelled Cheque to be attached for RTGS
Date of Resignation (DOR): Last Working Day (LWD):
Present Address of the Employee
Mobile: Personal e-Mail ID(for exp. letter):
Get clearance from the respecitve functions:
1 Immediate Reporting Manager Next Level Reporting Manager Uniform (Where Applicable)
(Not required for TMs/CSAs/GREs and Uniform returned: (Yes / No)
Equivalent Employees at Store Level) If No, Uniform Recovery Amount
If e-mail ID forwarding required, mention ID
Date & Signature: Date & Signature: Date, Signature and Stamp:
Name & Designation: Name & Designation: Name & Designation:
2 Administraton
ID Card: Business Card: Drawer/Desk Keys:
Access Card/ AEP & Biometric Pass(wherever applicable):
SIM Card: Outstanding Mobile Bill Amount (If exceeding the limit):
Mobile set or any other asset issued, if any:
Data Card, if any: Date & Signature:
Outstanding Data Card Bill Amount: Name & Designation:
3 Training Department, as applicable
Training modules returned/ CDs: Date & Signature:
Any other recoverable: Name & Designation:
4 Finance & Accounts (Corporate Finance Desk or In Co-ordination with the Corporate Finance Desk, Corp Desk will be Final)
Imprest, if any: Advance, if any:
Reimbursement (Dr/Cr), if any: Date & Signature:
Any other recoverable/ payable: Name & Designation:
5 Finance & Accounts (Store Imprest Pay Card) Date & Signature:
Name & Designation:
6 IT Department (Not applicable for Store Level employees below Store Number 1 Leader)
Laptop returned, if any:
Laptop bag returned, if any:
Laptop charger returned, if any:
Any other asset issued(Harddisk, pen drive, camera etc.), if any:
De-Activation of E-mail ID, if applicable:
Forwarding of E-mail ID & Change of Password, if applicable: Date & Signature:
Any deduction towards damage/ loss (Mention Amount) Name & Designation:
7 No Dues Receipt Details (For Payroll Team Purpose Only) 8 Leaving Employee Section
Exit Documents Received on: Signature: Have read & acknowledge all the above sections
and request to process my Full & Final
No Dues Completion Date: Signature:
Employee Signature with Date
Note: Point Number (2 to 5) are not applicable for Team Members/CSA/GRE/ & Equivalent employees at Store level.
Note: In case of e-mail ID forwarding, it is mandatory to change the password by Team IT.
Note : Cancelled Cheque to be attached along with the completed No Dues Form for F & F Payment Through RTGS/NEFT.
Note : All fields are mandatory, Incomplete No Dues Form will not be processed
