Professional Documents
Culture Documents
: 01
Rev. No. :02
Page 1 of 1
1 Name
2 P S No.
3 Department / Project.
4 Machine Name
5 Duration From Date /Time
6
Date /Time
Duration Up to
7 Purpose
I assure that the privilege(s) given to me shall be used only for business activities and will be abide by
the confidentiality agreement made with the company.
Signature of Requester
Name:
Department:
Mobile No:
As per the business need I authorize the concern for the special privileges for the mentioned period.
Signature of HOD/ PM
Name / P S No. :
Signature of HOD – IT
This document contains information which is confidential and proprietary to L&T Construction Transportation
Infrastructure. It shall not be reproduced in whole or in part or released to any third party without the prior
written consent of L&T Construction Transportation Infrastructure.