Hi Swarup,
This format has come out very well. I am sure you may have done a lot of research before preparing it. You have almost covered all the necessary aspects for F&F settlement. I am not sure whether your company has LTA, Medical Allowance, and Hospitalization claims for their employees. In general, Medical Allowance up to Rs.15,000/- is exempted from tax, so many companies pay it separately and do not show it on the pay slip.
If LTA and Medical allowances are provided, then the balance amount of LTA and Medical should be reflected in the format. One more thing, you have shown 'reversal of PF Deduction' from the salary, which means you are refunding the deducted PF amount to the employee. In general, and also in our company, 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