Hi Swarup,
This format is really comeout very well, I am sure you may have done lot of research before preparing it.
You had almost cover all the necessary heads for F&F settelment.
I am not sure whether your Co. has LTA & Medical Allowance & Hospitalisation claim for their employees. (In general Medical allowance upto Rs.15,000/- is excempted from Tax, so many Co. pays it separately and didn't show it on pay slip.)
If LTA & Medical is there, then the Balance amount of LTA & Medical should be reflected on the format.
One more thing, you have shown 'reversal of PF Deduction' from Salary, it means you are refunding the deducted PF amount to the employee.
In general and also in our Co. we never refund the PF amount once deducted from the salary, even when the employee is leaving us.
I am attaching another format, just for your reference.
Overall, Good work done!
Regards,
Mustaq