MID - Hand Over Form

Physical Hierarchy

Parent entity number: POD

Name: PROCUREMENT DEPARTMET

Entity Description
Name: KYB-SITE-17006
Classification: Keyboard DELL
Service date: 01/4/19 14:00
Status: GOOD CONDITION
Serial number: CN0644G3716166AL0AUM
Detail List
ID Name Classification Serial Number Note
KYB-SITE-17006 DELL Keyboard CN0644G3716166ALOAUM

Important :
Marking the notes using check mark (V) for present or cross sign (X) for not available.
Make sure all entities are correct before you sign this form, it will be used by MID as an evidance for any required auditing.

Given by Received by Receiver Superior :

Name : YOHANNES VERIZAL Name : ……………….. Name : ………………..

NIK :............................. NIK :.............................. NIK :..............................
DESCRIPTION
Updated 4 February 2019, These KYB-SITE-17006 has been delivered to Kodai Yoshino (POD-17010 / IP.
10.38.105.9)

Pt. Tanjungenim Lestari Pulp and Paper

Printed by: YOHANNES VERIZAL Page: 1 of 1