ACCEL FRONTLINE LIMITED

STAFF SETTLEMENT FORM - (SSF) Name : _________________________ Emp code : __________ Location : ______________ Designation : ____________________________________ Division : ___________________ Address for Communication: ___________________________________________________ ___________________________________________________________________________ Contact No. : ________________________________________________________________ Date of Joining : __________________________ Date of Resignation : _________________ Last Working Day : _______________________ Month upto which Salary was paid : ______________________ LOP if any : _______days (from last paid salary to last working day) Valid Agreement / Bond : Yes / No Total pending Vouchers / Claims: Rs.___________ ( Vouchers and Statement to be enclosed ) Travel Advance : Rs.___________ (amount to be recovered) Salary Advance : Rs.___________ (amount to be recovered) Other Recovery : Rs. ___________ (eg.: Tool Kit, Lap Top, Office Equipments etc.) Net PL as on LWD : __________________ Net CL as on LWD : __________________

FIL PL balance (as on 31-10-1999) _______ (If applicable) Pending Special Project Allowance to be paid for: ______ days (applicable only for ERP Division) Project Site : _____________________ Note: 1) To be filled in by Admn.-in-charge 2) All columns have to be filled. Please do on leave any column blank. Instead write Nil 3) The SSF will be returned, if any column / columns are left blank. Employees Signature :

Signature of Location Admin-in-charge

Signature of HOD / Location Head

(A) Staff Loan (B) PF Loan

SEPARATION CHECK LIST : :

YES / NO YES / NO Value in Rs. __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________ __________

(C) Check if the following is Returned / Accounted for : 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Laptop Mobile Phone Calculator Spares Toolkit Company Files Library Books Desk & Other keys Floppies Manuals Price List Any other Items (Please Specify) YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA YES / NO / NA

(D) Privilege Leave of the employee: 1. 2. 3. 4. Due beginning of the year Earned during the year Availed during the year Net PL balance : _____________________ : _____________________ : _____________________ : _____________________ : Yes / No

(E) Company Leased Accommodation Amount of Deposit with Landlord Date of Service of notice to landlord (attach a copy of the letter) Details of adjustment of advance / security deposit (F) Company Car Date of return of Company Car (attach original declaration signed by the employee and Location Admn. Manager) Name of the person in whose custody the keys, documents like RC book, insurance, tax token etc have been handed over

: Rs.___________________ :______________________ : Rs ___________________ : Yes / No

: _____________________

: Mr.__________________

(G) Land Line Telephone : When was the bill paid ? Amount to be paid / recovered : :

Yes / No ________________________ Rs._____________________ ________________________ Yes / No : : ________________________ Rs. _____________________ ________________________

Date of return of telephone instrument to the Company : (H) Mobile Telephone : When was the bill paid ? Amount to be paid / recovered

Date of return of telephone instrument to the Company :

EMPLOYEES DECLARATION : I confirm that I have returned all items to Accel Frontline Limited, viz, Laptop, Calculator, Mobile, Company files, library books, Keys, etc. I authorize Accel Frontline Limited to recover any outstanding amount or value of goods, and services due to company before making the full and final settlement. In case payment due from me is more than the amount due to me, I undertake to pay the difference to Accel Frontline Limited within 15 days of receipt of communication from the Company.

Signature : Enclosures: 1) 2) 3) 4) Enclose Leave Card PF withdrawal Form Family Pension Scheme withdrawal Form (Form 10C) Superannuation Form - (a) Plan Option Form (b) 5) 6) 7) Gratuity Form Specimen Signature Form

Date : Reason : YES / NO / NA : YES / NO / NA : YES / NO / NA : YES / NO / NA : YES / NO / NA : YES / NO / NA

_______________ _______________ _______________ _______________ _______________ _______________ Insurance Card (Employees and his dependents) : YES / NO / NA _______________ ID Card : YES / NO / NA

_______________

8)

Original / Copy of Resignation letter

: YES / NO

___________________ Note: If the above enclosures are applicable and are not enclosed, please specify the reasons for each and every item

Signature of Location Admin-in-charge

Signature of HOD / Location Head

ANNEXURE 31 CHARGE HANDING OVER REPORT In pursuance of the letter dated ______________ I, ______________________ do hereby hand over the charge on this day. 1) Files in my custody : File No. Subject Location

2) Any other documents in my custody : Description Subject

Location

3) Certified that all Performance Appraisals of all employees under my control have been filled up and submitted to :

4) All keys of my drawer / cupboard / filing cabinet, etc., have been handed over to Mr/Ms. : 5) Certified that I have handed over charge of my mailbox including user I.D. password, etc., to Mr/Ms ___________________ on _____________ and have intimated him/her about as and when it is to be deleted. 6) All the important issues pending are listed below : File no. with date Description

7) A brief situation report on the problems faced by me and strategies adopted, decisions taken but yet to be implemented are enclosed :

_______________________________ Signature of the Relinquishing Officer

___________________________________ Signature of the Officer taking over charge

_________________________________ Signature of the Head of Department

EXIT INTERVIEW FORM 1. NAME OF EMPLOYEE : 2. DESIGNATION : 1. DATE OF JOINING ACCELICIM : 2. REASONS FOR LEAVING : GRADE :

3. ANY PARTICULAR INCIDENT WHICH TRIGGERED THE THOUGHT OF LEAVING :

4. YOUR RELATIONSHIP WITH SUPERIORS : 5. YOUR PEER RELATIONSHIP : 6. YOUR SATISFACTION LEVEL WITH COMPANIES BENEFITS : 7. IN YOUR OPINION HAVE YOU BEEN ASSESSED FAIRLY IN THE PERFORMANCE APPRASIAL SYSTEM :

8. ARE THE INCENTIVE SYSTEMS JUST & FAIR AND REFLECTIVE OF INDIVIDUAL PERFORMANCE : 9. ARE YOU LEAVING FOR MONETARY BENEFITS :

10. ANY SPECIFIC POINT YOU WANT TO SHARE WHICH WILL ENABLE US TO TAKE CORRECTIVE ACTION FOR THE BETTERMENT OF THE COMPANY IN FUTURE : DATE SIGNATURE OF INTERVIEWER.

PF SETTLEMENT FORM ACCEL ICIM PROVIDENT FUND II Floor, Progress House, 54, Pune-Mumbai Road, (Wellesly Road), Shivaji Nagar, Pune 411005. I request you to pay me the full amount standing to the credit of my account in the Fund after making such deductions as per Rules 15 of the Fund. 1. Name (in BLOCK letters) 2. Fathers name (or husbands name in case of married woman) 3. Staff No. 4. (i) Ground on which the request for withdrawal is made (See Footnote 1) (ii) Date of leaving service. 5. The payment may be made at the following Address :

I certify that the particulars given above are true to the best of my knowledge * I declare that I have not been employed in any factory / Establishment to which the EPF Act applies for a continuous period of not less than two months immediately preceding the date of my application for final withdrawal of my P.F. money. (See footnote 2) Dated. 200 Enclosures .. (See footnote 3) Signature of the Member

Notes : 1) Grounds for withdrawal : (a) Retiring from service after attaining the age of 55 years, b) Retiring on account of permanent and total incapacity for work in any industry due to bodily or mental infirmity, (c) Migrating from India for permanent settlement abroad, (d) being a national of country other than India is leaving India at least for a year, (e) Has not been employed in any factory to which the EPF Act applies for a continuous period of not less than 2 months immediately preceding the date of application. 2) Strike out if not applicable. 3) If the claim for withdrawal is made on ground mentioned in 1(b) above a certificated by registered medical practitioner or the Medical Officer of the factory should be enclosed.

Advance Stamp Receipt Received a sum of Rs. ______________ (Rupees _______________________________) from Trustee, ACCEL ICIM Provident Fund vide Cheque / DD No. ________ dated ____________ towards the settlement of my Provident Fund Account.
1 Rs. Revenue Stamp

Signature of the member

ACCEL FRONTLINE LIMITED, 75, Nelson Manickam Road, Chennai -29 Sir, I hereby apply for a payment of Gratuity to which I am entitled under Companys Gratuity Scheme on account of services rendered as detailed below : 1. Name in full : 2. Address in full :

3. 4. 5. 6. 7. 8.

Department where last employed : Staff Code No. and Designation : Date of Appointment : Date of Leaving service & Reason thereof : Total period of service : Last Salary drawn : Basic :

Total:

Payment may please be made by crossed bank cheque Yours faithfully,

Name : Staff Code : Place :

Dated :

ADVANCE STAMP RECEIPT

Received a sum of Rs (Rupees. .) from Accel ICIM Employees Group Gratuity Trust 75, Nelson Manickam Road, Chennai 29, vide Cheque No.. dated towards the Full & Final Settlement of my Gratuity Dues. Affix Revenue Stamp of Re.1/(Signature of the Member)

SPECIMEN SIGNATURE FORM 1. Name of the Fund : 2. Master Policy No. : 2. Name of the Member : __________________________________________________ 3. Employee ID of the Member : ____________________________________________ 4. Date of Birth of the Member : ____________________________________________ 5. Date of Joining Service : ________________________________________________ 6. Date of Leaving Service : _______________________________________________ 7. Name of the Beneficiary : _______________________________________________
8. PARTICULARS OF BANK ACCOUNT :

(a) Account No. _________________ (b) Nature of Account (Whether Joint with beneficiary or Single) _______________________________ (c) Name and address of the Bank _________________________________________ __________________________________________________________________ (d) Address of the nearest State Bank of India _______________________________ __________________________________________________________________
SPECIMEN SIGNATURE OF THE BENEFICIARY AND THE MEMBER

Specimen Signature of the Member

Specimen Signature of the Beneficiary

1. ____________________________1. _____________________________ 2. ____________________________2. _____________________________