EXIT PERMIT / IZIN KELUAR

To be completed for / Dilengkapi untuk:

A. Camp residents leaving the site / Penghuni camp meninggalkan site
B. Vehicles carrying goods of value / Kendaraan mengangkut barang berharga
Camp Residents Names / ID Number / Destination / Purpose /
Nama Penghuni Camp Nomor ID Tempat Tujuan Tujuan
1.  Local / Lokal Ember untuk cuci di kem
2.  Sibolga
3.  PSP
4.  Other (please specify) /
5. Lainnya (mohon dijelaskan)
6. ........................................................
........................................................

Goods of Value* / Barang Berharga* Qty / Jumlah

1. ember 2 ea
2.
3.
4.
5.
Approval Sr. Manager or Manager of Department / Persetujuan Sr. Manager atau Manager Departemen
Name /

Nama

Position /

Posisi

Signature / Ttd

Date /

Tanggal

Martin Hancock

Site manager

21 /09/2020
Note: Approval required for all Camp Residents, PTAR Vehicles & LCI Vehicles / Persetujuan diwajibkan untuk seluruh penghuni
kamp, kendaraan PTAR & LCI.

Owner (Dept./Company) /
Pemilik (Dept./Perusahaan)
PT. INDODRILL INDONESIA

Vehicle / Kendaraan:
Police No. / No. Polisi / Company No. / No. Perusahaan

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G-HSS-SEC-FRM-00049-IE EXIT PERMIT Version 1.1
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 28 October 2020
Driver / Pengemudi:
Name / Nama / ID No. / No. ID

Date / Tanggal
21 /09/2020

Security Check – To be completed by security / Pemeriksaan Sekuriti – Dilengkapi oleh sekuriti

Name /

Nama

Badge No. /

No. Badge

Signature / Ttd

Date /

Tanggal

Time Exiting Gate /

Waktu Keluar Gerbang

21 /09/2020

*Note / Catatan:
Electrical Cable, any size, condition or quantity.
Kabel Elektrikal, segala jenis ukuran, kondisi atau jumlah.
Rig Materials,,,Portable Equipment, generators,avtur,solar
etc.
New Goods, any item still in its original unopened packaging.
Barang baru, setiap barang yang masih original dan masih
terbungkus.
Rig materials,portable egp,genset, Avtur, Solar, dll.

P a g e | 2 of 2
G-HSS-SEC-FRM-00049-IE EXIT PERMIT Version 1.1
UNCONTROLLED COPY IF PRINTED. VALID ON DAY OF PRINTING ONLY - Printed on: 28 October 2020