UTILIZATION OF COMPANY VEHICLE

Police Number : ____________________________

Driver Name : ____________________________
Destination : ____________________________
Department : ____________________________
Purpose : __________________________________________________________________
__________________________________________________________________

DATED OF DEPARTURE
Dated :

Time :

DATED OF RETURN
Dated :

Time :

Noted : _________________________________________________________________________________
_________________________________________________________________________________

Subang, _______________________

Prepared by, Acknowledge by, Approved by,

___________________ ___________________ __________________

Department Head

For Driver Use Only

Km/Departure :

Km/Return :

Noted :

HRD.27-Rev-00