e NEWIEXTENTION. —_— REQUEST FORM G.I.P AND BADGING & | contractor NAME +1 OV.IKB Fare ine i eoeee coe el oe rae 8] request pare 27 Desember 2022 ee i cues ae REMARK (SEE NOTE) NAME heal (Print Full Name) a @ loasa. a. [Supratman Person Local 2. |suvisno Person Local CONTRACTOR TO COMPLETE |Summary of total manpower to date origina contract : JAdational (Last request) Jacational (his request) [Total to date Lustiication Note: Pesce mar: 1) Subcontractor: Name of Subcontractor which supply the person 2) iret Hire Loca: Loca District (Huu, Dompu, Bima) 53) Direct Hire Outsider: Non Local a item 2 above The contractor shal provide justicaton when request IP/Badging for Manpower replacement ‘2d shal attach Contract instruction or Contract Variation for each badging/GIP request. ‘THE CONTRACTOR MUST : 1. Atached the copy of 1D card (arta Tanda Fenduduk) for each person You proposed 3: Submit the form as attached (Attachment 1 Manpower Information Data) «for new employee 3: Attached Copy of Medical Fit Crtfcate esved by vad nettution | Gonvacor shoud submit REQUEST FORM of GIP AND BADGING, atleast Smorkng-days. riot to GIP being conducted Proposed by, Approved by: oproved by: VR C vem eo ‘Approved by:No. badge Contractor Name Full Name / Nama Lengkap Address / Alamat Local / Non Local Home Phone / Mobile / No. HP State / Bangsa Place/Date of Birth (D.0.H )/T.T. Lahir Date of Hire / Tanggal Diterima Point of Hire (POH) / Tempat Diterima Marital Status / Status Pernikahan Gender (UP) ID Number / No KTP Position / Posisi Departement Education / Pendidikan Emergency Contact, Other Information Proposed By, Contractor Name BIN ATTACHMENT 1 MANPOWER DATA INFORMATION bou Kee, Hu'u Kab, Dompu .§205030709850002 Mason. Approved By, En Contract Owner Name = BIN:MANPOWER DATA INFORMATION No. badge Contractor Name Full Name / Nama Lengkap Address / Alamat Local / Non Local Home Phone / Mobile / No. HP State / Bangsa Place/Date of Birth ( D.0.H )/T.T. Lahir Date of Hire / Tanggal Diterima Point of Hire (POH) / Tempat Diterima Marital Status / Status Pernikahan Gender ( LIP ) ID Number / No KTP Position / Posisi Departement Education / Pendidikan Emergency Contact Other Information Proposed By, Contractor Name : BIN ATTACHMENT 1 Approved By, Contract Owner Name : BIN