Benefits Clearance Request | University of Miami

Benefits Clearance Form

Clearances are processed during regular business hours. Please allow 48 hours for the process to be completed. Once the employee has been cleared, you will receive a confirmation email. Please submit ONE employee's clearance per form request.

Please review our privacy statement relating to information we collect, choice/opt-out, and correction/updating of personal information before proceeding.

* Name of Separating Employee: (You must type in a response)

* Separating Employee's "C" Number: (You must type in a response)

* Separating Employee's Department: (You must type in a response)

* Date of Separation: (You must type in a response)

Please enter in this format: MM/DD/YYYY

* Reason for Separation: (You must select one)

	Retirement
	Termination
	Lay Off
	Resignation
	Death

* Name of Employee Initiating Clearance: (You must type in a response)

* "C" Number of Employee Initiating Clearance: (You must type in a response)

* Email of Employee Initiating Clearance: (You must type in a response)