IBRANAMED
EMPLOYER :
Name-Surname-Title :………………………………………………………………………….
Address :…………………………………………….. ………………………….
SSI Workplace Registration Number :……………. …………………………………………………………..
WORKER :
Name and Surname : ………………………………………………………………… ………
SSI Insurance Registration Number : ………………………………………………………………………….
Date of Commencement of Employment : ……/ ……/… ….
Date of Termination of Employment : ……./…… /…….
Reason for Termination of Employment : …………………… (Abandonment, Resignation, Dismissal, Patriotic Duty,
Retirement, Death, Other)
…………… /……/ …….From ……………………………………………, where I have been working since
I am leaving due to ……………………….. All the wages I have earned until the date of my departure
and I received the remainder of my rights at the time of my departure as shown below.
I do not have any in-kind, cash or social rights due to my contract and legal rights.
Therefore, I will not make any material and moral claim from my workplace.
I hereby declare and release that I have received all my rights from the date of my resignation until the beginning of my service contract
…………………………………………………………………………………………………../ …/ …….
Wages and other payments due to the worker on the date of departure, as he/she is entitled to them by deduction of his/her account:
TYPE OF PAYMENT GROSS AMOUNT LEGAL AND SPECIAL DEDUCTIONS NET
PAID
1-Earned Monthly Wages ……………….. ………………………. ………………..
2-Overtime Wages ……………….. ………………………. ………………..
3-Unused Leave Fees ……………….. ………………………. ………………..
4-Social Rights ……………….. ………………………. ………………..
5- Notice Pay ……………….. ………………………. ………………..
6-Senior Severance Pay ……………….. ………………………. ………………..
TOTAL PAYMENT ……………….. ………………………. ………………..
PAYER
Name and Surname – Signature
Address and Telephone No
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