Title Page
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Conducted on
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Prepared by
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Employee Name
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Payroll Number
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Site
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Date employee has left
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Reason for leaving
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Employee has returned uniform items issued?
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Amount to be deducted from final wages due
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Any additional deductions to be made from final wages due?
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Amount to be deducted
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Please note that leaving certificates should be signed by both employee and Manager
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Employees Signature
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Manager Signature
