Full and final settlement statement

What should I give an employee who is leaving, to show what is paid and what is deducted?

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A full and final settlement statement is one page that lists every amount due to a leaving employee, every deduction, the net amount, the date of payment and a signed acknowledgement. It gives both sides a record of what was settled.

Timing is set by law for wages. Section 17(2) of the Code on Wages, 2019 provides that where an employee is removed, dismissed or retrenched, or has resigned, wages are to be paid within two working days of that event. The statement records the payment date you enter.

Gratuity runs on its own steps. Section 53(2) of the Code on Social Security, 2020 sets fifteen days' wages, or such other number of days as the Central Government notifies, for each completed year or part above six months. Rule 33 of the Social Security (Central) Rules, 2026 has the employee apply in Form-IV and the employer answer in Form-V within fifteen days. The statement carries the matching paragraph for the option you choose.

What you get

Full and final settlement statement, as a Word file to edit and a PDF to print

Example with made-up names

Full and final settlement statement

Date: 24 October 2026

Employer: Kestrel Design Studio Private Limited, 14 Tulsi Road, Indore, Madhya Pradesh 452001.

Employee: Arjun Mehta, Senior Designer.

Employee ID: KDS-0142

Date of joining: 5 April 2021. Last working day: 16 October 2026. The employment ended by resignation.

This statement sets out the amounts due to Arjun Mehta on the end of employment, the deductions made, and the net amount payable.

Amounts due

No.	Description	Amount
1	Salary for 1 October to 16 October 2026	₹42,000
2	Leave encashment for 6 days	₹16,800
3	Expense reimbursement	₹3,250

Total of the amounts due: ₹62,050

Deductions

No.	Description	Amount
1	Advance recovered	₹10,000

Total of the deductions: ₹10,000

Net amount payable

The net amount payable is ₹52,050. It will be paid by bank transfer on 26 October 2026.

Gratuity is not part of this statement. Under rule 33 of the Social Security (Central) Rules, 2026 the employee applies in Form-IV, ordinarily within thirty days of the date it became payable. The employer then issues a Form-V notice within fifteen days of the application, fixing payment on a date not later than the thirtieth day after the application or giving reasons for rejection.

Signed for the employer

Meera Joshi

Director

for Kestrel Design Studio Private Limited

Acknowledgement by the employee

I, Arjun Mehta, acknowledge that I have received this statement.

Arjun Mehta

Date of receipt of the statement: ____________

I acknowledge that I have received the net amount of ₹52,050 by bank transfer.

Arjun Mehta

Date of receipt of payment: ____________

Fill in your own

The employer

Employer's name *

Employer's address *

The employee

Employee's name *

Employee IDLeave it empty if there is none.

Designation *

Date of joining *

Last working day *

How did the employment end? *

The amounts

Amounts due to the employee *

Amount due 1

What it is for *

Amount *

Salary, leave encashment, bonus, reimbursements and any other amount due.

Deductions

Deduction 1

What it is for *

Amount *

Leave it empty if nothing is deducted.

Total of the amounts due *Add up every amount due above.

Total of the deductionsAdd up every deduction above. Leave it empty if there are none.

Net amount payable *Check that it equals the total of the amounts due minus the total of the deductions.

Gratuity *

Payment and signature

Date on the statement *Today, or any day in the next seven days.

Date of payment *

How will it be paid? *

Name of the person who signs for the employer *

Role of that person *

We keep your answers and number so we can help if you ask. Ask us at any time and we delete them.

BuildWright does documentation, filing and compliance facilitation. This tool works from the rules cited on this page and does not give legal advice. We prepare the documents from your answers; you check, sign and send or file them.

If this is where you are

I left my job and the employer has not paid my last salary, gratuity or other dues, and has not given my relieving letter.

Demand letter to a former employer for unpaid dues

A dated demand to HR with a copy to a director, a statement of dues and a sheet with the deadline and the rule for each item.

Demand for payment of my final dues
Statement of dues
Before you send

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Common questions

How soon must a leaving employee's wages be paid?

Section 17(2) of the Code on Wages, 2019 provides that wages are to be paid within two working days of removal, dismissal, retrenchment or resignation. The same sub-section covers an employee who becomes unemployed because the establishment closes.

Does the statement include gratuity?

It can. If you list gratuity among the amounts due, the statement quotes the section 53(2) rate, fifteen days' wages or such other number of days as the Central Government notifies. If gratuity is handled apart, the statement describes the Form-IV and Form-V steps of rule 33 instead. The form does not calculate the gratuity amount, so work that out first and enter it.

Does the form add up the amounts?

No. You enter the two totals and the net amount yourself, so check that it equals the total of the amounts due less the total of the deductions before you download.

Does the employee have to sign?

The statement has two acknowledgement lines, one for receipt of the statement and one for receipt of the payment. They give you a dated record of each. This page does not say what effect a signature has on any later claim.

Source: Code on Wages, 2019, section 17(2): wages within two working days of removal, dismissal, retrenchment or resignation. Read 18 October 2026. Sections 1 to 41 brought into force on 21 November 2025 by S.O. 5322(E); section 17 falls inside that range.
Source: Code on Social Security, 2020, section 53(2): gratuity at fifteen days' wages or such other number of days as the Central Government notifies, for each completed year or part above six months. Read 18 October 2026. Sections 17 to 141 brought into force on 21 November 2025 by S.O. 5319(E); section 53 falls inside that range.
Source: Social Security (Central) Rules, 2026, rule 33: gratuity application in Form-IV, employer's Form-V notice within fifteen days, payment by the thirtieth day. Read 18 October 2026. Gazette of India Extraordinary of 8 May 2026 (G.S.R. 344(E)), in force on publication.

Work out the figures firstUse the Gratuity Calculator. It is free and nothing you enter is stored.The next step, handled for youEmployee Separation Kit: we prepare the papers and take you through sending them.