IBRANAMED
EMPLOYER :
Name-Surname-Title :………………………………………………………………………….
Address :…………………………………………….. ………………………….
SSI Workplace Registration Number :……………. …………………………………………………………..
WORKER :
Name and Surname : ………………………………………………………………… ………
SSI Insurance Registration Number : ………………………………………………………………………….
Employment Start Date : ……/ ……/… ….
Date of Resignation : ……./…… /…….
Reason for Leaving the Job : …………………… (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 that the employee is entitled to receive on the date of departure by deducting 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 Compensation ……………….. ………………………. ………………..
6-Seniority Indemnity ……………….. ………………………. ………………..
TOTAL PAYMENT ……………….. ………………………. ………………..
PAYER
Name Surname – Signature
Address and Telephone No
You can access our other article examples and petition examples by clicking