………………………….

PRIVATE LIMITED

FULL & FINAL SETTLEMENT

Date :

NAME : Mr. DESIGNATION :

EMP. NO.: DATE OF JOINING :

DEPT. : DATE OF LEAVING :

DETAILS OF PAYMENT DEDUCTIONS

SR.NO DESCRIPTION NO.OF MONTHLY TOTAL SR. DESCRIPTION DEDUCTION

DAYS PACKAGE PAYMENT NO. AMOUNT
1 CURRENT MONTH 1 P.F.
DAYS 30 2 P.T.
2 BASIC 3 ADVANCE/IOU
3 HRA 4 LOAN -
4 OTHER ALLOWANCE 5 TDS -
5 CONVEYANCE 6 NOTICE PAY -
6 MEDICAL ALLOWANCE ( Days)
7 NOTICE PAY - 7 P.F ON LEAVE
8 LEAVE SALARY ENCASHMENT.
9 EX-GRATIA -
10 ARREAR 2004-05
11 GRATUITY -
TOTAL
NET PAYABLE RS.
(Rupees :………………………………………………………………………….)

PREPARED BY CLEARED BY AUTHORISED BY

DATE :

RECEIPT

CERTIFED THAT I HAVE RECEIVED MY FULL & FINAL SETTLEMENT FROM THE COMPANY ON THIS DAY
BY WAY OF CHEQUE FOR RS. ONLY BEING THE FULL & FINAL SETTLEMENT OF MY DUES
AND I HAVE NO FUTHER CLAIM OF WHATSOEVER NATURE IN FUTURE.

I say, Received

Name of the Employee.

Designation