CLEARANCE FORM

(To be completed before Relieving)

Mr./ Mrs./ Ms.: UPI Code :

Date of Resignation : Date of Relieving :

Business Unit: Date of Joining :

Business Title : Location :

Email id: Tel No.

Address For Future Communication :

S.No Clearance Details Clearance By: Name of the Signature

Employee
BU / Functional Head

1 Business Unit Head’s clearance for relieving. Business Unit Head

2 Exit Interview Form Supervisor

3 All official documents/CDs/Process handed over Supervisor
4 Transfer of GPM record to the new supervisor Supervisor
5 Personal Disk space cleared on Computers. Supervisor

Remarks :

Administration Department
6 Employee ID Card/Access Card Admin
7 Drawers cleared and keys returned Admin
8 Mobile handset and Sims Cards Admin
9 Data Card Admin
10 Release of Company Leased Accommodation Admin
11 Parking Sticker Admin
12 Balance Visiting Cards Admin
13 Transport Admin
14 Telephone connection (if any) Admin
Remarks Admn :

IT Department

15 Lap Top / Desktop and Accessories Local IT

16 Voice Messaging Service (audix) Local IT
17 Authorization Code for STD/ISD Local IT
18 NT Account Local IT
19 Remote Access Token Local IT
20 Deactivation from Mailing List Local IT
21 Calling Cards Local IT
RELIANCE IT / COMMERCIAL Department (To be signed by Reporting Manager)
1 GYANMANDIR & SAP Access Deactivated Reliance
2 Role Based Access (If Any) Deactivated Reliance
3 Clearance Only For NNOC Employees: ↓
NETKT / REMEDY / CLARIFY / CLARITY Deactivated Reliance
Remarks:

CFO
22 Hard Furnishing Assets, if any Local CFO
23 Payments due if any, to travel agents completed. Local CFO
24 Loans / Deposits Local CFO
 25 Company Leased Car, if any Local CFO
26 American Express card Local CFO
27 Settlement of all dues Local CFO
28 Off-Hours payment Local CFO
29 Submission of all expense vouchers due. Local CFO

Remarks by CFO :
HR
30 Intimation to HR SPOC for deactivation of UHC card HR Person
31 Library card / books HR Person
32 Acceptance Letter subject to clearance of dues. HR Person
33 Employee Referral Amount HR Person
34 Joining Bonus, if Any HR Person
35 Relocation Expenses, if Any HR Person
36 Training Bond recovery amount HR Person
37 Balance leave status HR Person ________days;
38 Notice period to be recovered HR Person ________days;
Remarks by HR :

OneHR Team :

39 Termination of record in psoft/X500 OneHR Team

Stores

40 Equipment (if any) Store in charge

Note: * This form should be returned to HR- Department , on or before the last working day

**Please do not keep any of the field empty, as incomplete form will not be entertained

***Some of the fields may not be applicable to all, in such case please mention N/A

**** Please submit the balance reimbursement and Income Tax proof documents alongwith the clearance form

Employee Signature: __________________________ Date : _________________________________

 ACKNOWLEDGEMENT OF OBLIGATIONS BY SEPARATION EMPLOYEE

Name of Employee ________________________________________ UPI: ____________________

Alcatel-Lucent Business Unit ________________________________ Date of Exit: _____________
New Employer: _________________________________________________________________________
Address: _________________________________________________________________________________________

I have been reminded of the following obligations:

1. My Obligation which continues after separation of employment not to publish, disclose, use or authorize anyone
else to publish, disclose or use without written authorization by Alcatel-lucent any private, confidential, or
proprietary information that I may have in any way acquired, learned, developed, or created by reason of my
employment.
2. My obligation upon separation of employment to return to supervisor all Alcatel-lucent property and all
documents in my possession or control which contain private, confidential, or proprietary information of
Alcatel-lucent.
3. My obligation after separation of employment not to use or disclose without authorization any computer or
network access code or password belonging to Alcatel-lucent or made available to me by virtue of my
employment, and not to access any computer, network, or database in the possession or control of Alcatel-
lucent.

“Private, confidential, or proprietary information” means information which is owned or controlled by Alcatel-
lucent and has not been publicly released or has not otherwise become common knowledge in its field of interest. It
includes information of third parties in the possession of Alcatel-lucent which Alcatel-lucent is obligated to maintain
in confidence. Examples of such information include:

a. Discoveries, inventions, and developments, including knowledge of unsuccessful approaches;

b. Scientific / engineering information, including information contained in patent applications, e.g. research
findings, materials, processes, designs of apparatus and equipment, engineering aids, installation manuals, and
computer software, architecture and logic. “Software” means any nontrivial, executable computer program
routine, whether in source or object code, in whatever form or medium recorded;
c. Technical management information, e.g. proposal, schedules and development of components and systems
performance objectives and criteria, and analyses of areas for development;
d. Financial information, e.g. product and service cost data, revenue and profit margins;
e. Business and marketing information and information relating to legal and regulatory matters, e.g. project
proposals, financial data, accounting work sheets, marketing studies, construction plans, contemplated new
ventures, customer information, unannounced future products, and strategies, existing and planned Alcatel-
lucent and customer network configuration and design, customer specific and billing information;
f. Personnel information, e.g. salaries, job assignments and skills, and merit reviews.

Such information does not include the employee’s general knowledge, skill, and experience. Proprietary information
may be in intangible form such as unrecorded knowledge, ideas or conceptions, or may be embodied tangible form
such as a document. The term “document” includes written memoranda, drawings, training materials,
specifications, notebook entries, photographs, graphic representations, firmware, computer information or
software, or models.

SIGNATURE OF EMPLOYEE: ________________________ DATE: ___________________

NAME OF WITNESS: ____________________________ BU: ___________________

SIGNATURE OF WITNESS: __________________________ DATE: ___________________

* Witness can only by the employee within the company