Revised May 2014

UNIVERSITY OF THE PHILIPPINES MANILA

8th Floor, Central Block, PGH Building, Taft Avenue, Manila

The Health Sciences Center

Name / Date
Position / Unit
Purpose: Resignation Optional Retirement Transfer
Other please specify / Effectivity

THE ABOVE-NAMED EMPLOYEE IS CLEARED OF MONEY, PROPERTYAND OTHER ACCOUTABILITIES FROM UP MANILA AS INDICATED:

1.a. Cleared from the unit level
b. Recommended for Univ.
Clearance / 2. Cleared from property
accountabilities / 3. No pending civil or Administrative case
Dean/Director/Head of Office / Supply Officer V / 3.a. OASH Coordinator / 3.b. Univ. Legal Counsel
4. Cleared from academic
Responsibilities (Faculty only) / 5. Alumni Relations (Faculty only) / 6. Cleared from NIH (Faculty only)
University Registrar / Director / Executive Director
7. Cleared from books and other
Library obligations / 8. No loan obligations:
a. Chief, Staff Housing & Buss. Con
b. Manager, Provident Fund
c. Manager, Credit Union Coop
University Librarian / d. Manager, Bayanihan Multipurpose Coop
9. Cleared of personnel matters: / 10. Cleared of cash accountabilities:
 SALN
 Exit Interview
 I.D.
 Service Obligation
 Terminal Leave /
  1. Chief Accountant, PGH

 Time Records/COS)
(Admin/REPS only)
 PES Rating
(Last rating period)
  1. Chief Accountant, UPM

Director, Human Resource Development Office
11. APPROVED
Vice Chancellor for Academic Affairs/Administration
Date

-Please see reverse side for Instruction-

INSTRUCTIONS

  1. This clearance should be duly accomplished before paying last salary or any money due to the employee from the University.
  1. Employee who is retiring (optional), resigning, being separated, transferring to other government agency prepares this form in four (4) copies.
  1. Clearing official should indicate employee obligation or accountability, if any, or if cleared, places signature on the space provided and the date below the signature.
  1. The HRDO distributes copies of approved clearance as follows:

Original-Employee

Duplicate-HRDO file

Triplicate-Accounting Office

Quadruplicate-College/Office where employee is assigned

Please be guided accordingly.