SS AGENCIES
140, Kamaraj Street, Salem,
Tamil Nadu – 636001.
Internal Gate Pass
Name: _______________ E.Code: _________
Dept: __________ Date: _________
Allowed to take following items/articles Out/In Form: _______ ________ To:__________
S.N Item Code Description Unit Quantit Remarks
o s y
1
2
3
4
5
Note: This gate pass used only for internal purposes
Pass IN/OUT
Security In-charge
Prepared By Received By Head of Department