Rev. 01

Ngi yu cu /Requester:

S in thoi / Phone No:

Cng ty / Company: Bin s xe / Vehicle Plate:

Tn li xe / Driver Name

Stt

No

S seriSerial No.

S lng

Quantity

n v Unit

1

2

3

4

5

6

7

8

9

10

Gip Php S / Gate Pass No: Ngy / Date:

Issue Date: 27 March 2015

Thi Gian / Time:Ngy / Date:Ni t vt t, Thit B / Place:

Ghi ch : Xc nhn ca i Mi trng JVD i vi st ph liu v g thi /

Note: Additional approval signatory is needed from JVD Env. Team to verify scrap metal and wood waste.

GIY PHP VN CHUYN VT T RA CNG TRNG

MATERIAL GATE PASS(OUT)

Ngi chu trch nhim An ninh an ton JGCS xc nhn/

JGCS Security Person In charge confirmed:

K v ghi r h tn /Name & Signature:

Ch k xc nhn ca nhn vin th kho JGCS/ th kho nh thu ph

quan st qu trinh bc hng/

Actual Loading witnessed and verified by JGCS material controller/Sub-con

Storekeeper:

H tn & K tn/Name & Signature:

Thi gian/Time: .........Ngy/Date:.......................................

- Giy php ny ch c s dng mt ln v phi l bn gc.

This GATE PASS is only single use and in original copy.

- Giy php ny ch c gi tr trong ngy tng ng vi ngy k ca th kho ca JGCS. This gate pass is only valid on the date the JGCS Material Controller or Storekeeper signed.

- Giy php mang vt t ra ngoi cng trng c hiu lc t 7:00 n 20:00 cng ngy.Material gate pass out used from 7:00 to 20:00.

2. THNG TIN CHUNG / GENERAL INFORMATION.

3. THNG TIN VT T / THIT B / EQUIPMENT / MATERIAL INFORMATION

1. HNG DN / INSTRUCTION:

Xc nhn ca nhn vin bo v JGCS/ An Ninh PVS /Checked by JGCS/PVS Security

H tn & ch k/ Name & Signature: Thi gian / Time: ....................

Ngy / Date: .......................

V tr / Position:

c im vt t, thit bDiscription of Material, Equipment

Ghi ch

Remark

4. KIM SOT CNG VIC / CONTROLLER BY

Xc nhn ca qun l nh thu ph / Confirmed by

Subconstractor Manager

Xc nhn ca ngi c trch nhim JGCS / Confirmed by JGCS person in

charge

S th / ID No:

S th / ID No:

userTypewritten textMAI THE TOAN

userTypewritten text173269545

userTypewritten textPVE

userTypewritten text0933 898 944

userTypewritten text36M- 1281

userTypewritten text164343244

userTypewritten textDINH CONG THANH

userTypewritten textZONE 2