NATIONAL IDENTITY MANAGEMENT COMMISSION

STAFF EXIT FORM

Note: This form must accompany all exit notifications to the HCM for further process.

Name of Employee *

File Number

IPPIS Number

Department/Unit

Designation

Grade Level

Location *

Official e-mail

Personal e-mail

Phone Number

Mode of Exit

Retirement

Date of Exit *

Your Name *

Staff Signature/Date:

ASSET

RETRIEVED BY (NAME/DESIGNATION)

SIGNATURE/DATE

REMARKS

Staff ID Card

Laptop

Desktop

ACCESS

RETRIEVED/DEACTIVATED BY (NAME/DESIGNATION)

SIGNATURE/DATE

REMARKS

Assess Card

Active Directory

RIGHT

UPDATED/CONFIRMED BY (NAME/DESIGNATION)

SIGNATURE/DATE

REMARKS

Payroll

Confirmation of Non-indebtedness

Not yet signed

Head of Department/Unit Head

Not yet signed

Head, Human Capital Management

(To be completed by HOD and HCM after processing — each row is signed digitally by the responsible role)