Leaving certificate

　　Name date of birth year month day

　　The male se-x.

　　Each female identity card number

　　Home addretelephone

　　Turnover turnover: year month day month wages actually

　　Working ground county ( city)

　　Reason for leaving

　　(this column can only select a ) a, involuntary separations:

　　- shut the factory - factory moved - - - closed dissolution declared bankrupt

　　The Labor Standards Law eleventh: - A - two - three - four - five

　　The Labor Standards Law Article fourteenth A: - A - two - three - four - five - six

　　Labor Standards Act thirteenth but the labor standard law twentieth

　　Each contract work: from year month date to expiration year month day

　　Two - three, voluntary turnover, other ( checked, be sure to text )

　　( ID card copy positive paste bar ) ( ID card copy back adhesive bar )

　　The insured units demonstrate that column ( of leaving certificate issued by the insured units please fill in this column ) ( please affix the official sealOr seal )

　　Insured unit name:

　　Insurance certificate insurance: telephone unit:

　　Insured unit address:

　　The table and recorded in the content of the information, industry by the insured units review accurate, if not willing to bear all legal responsibility.

　　The insured units contact: contact telephone number:

　　Authority of that column ( of leaving certificate by the local authorities issue please fill in this column, and please fill issued authority of reason ):

　　( please seal or stamp at )

　　The applicant 's own interpretation bar ( of the certificate leaving office to the insured units and the labor administration authority for cannot obtain please fill in this column )

　　, if not willing to bear all legal responsibility.

　　Applicant ( signature )