Haripur Power Limited

VISITORS COMPLIANCE STATEMENT

I/We have read and fully understand the above rules and procedures mentioned in HPL Visitor Check-
in Sheet and Visitor Safety Rules (APPENDIX 3.1). I/We have been informed of the proper actions to
take in event of a site/plant emergency.

Name: ___________________ Name: ______________________

Company: ___________________ Company: ______________________

Signature: ___________________ Signature: ______________________

Date: ____________________ Date: ______________________

Name: ___________________ Name: ______________________

Company: ___________________ Company: ______________________

Signature: ___________________ Signature: ______________________

Date: ____________________ Date: ______________________

Name: ___________________ Name: ______________________

Company: ___________________ Company: ______________________

Signature: ___________________ Signature: ______________________

Date: ____________________ Date: ______________________

Form Number: HPL-SP-028-F-1 Issue-A