ATTACHMENT10

EMPLOYEE CLEARANCE FORM

NAME : MOHD AZMIN BIN MOHD ZAIN
EMPLOYEE NO :
DEPARTMENT / PROJECT : CENTRAL DIRECTORATE SECURITY / PMT SECURITY / PIC SECURITY
LAST WORKING DAY : 13 JANUARY 2018
COMPANY NAME : TECHNIP GEOPRODUCTION (M) SDN BHD

*** (Please call ahead to ensure person is available to perform clearance)

Surrender Passport : Site HR Date : Sent to KL : Date:

Particular : DEPARTMENT / NAME SIGNATURE DATE

Air Ticket & Passport (s) for immigration Clearance Not

HR - KL
Passport & Tax Clearance Not

Return of Company Access Card Not

SITE HR
Medical Card Not

Return of safety Gears Not

1. Safety Boots Not

2. Safety Helmets Not

3. Safety Glass Site Admin - Muzafar Not

4. Reflective Vest Not

5. Life Jacket Not

6. RAPID Jacket Not

Site Accommodation - Kamal

Hotel 'Check out' notification & Keys / Accommodation key Long (SPC), Zaidon (RTEV), Vijay Not
(Lotus)

Return of Diesel Card Not

Fleet Vehicle - Lee Beng Khuan
Return of Company's Car & Clearance of Summons (if any) Not

Return of Hand phone (if applicable) Not

Return of Company's Camera Site Admin - Nurezzatul Not

Return of Keys - Drawers, Cabinets & Room Not

Return of Telephone Set (Office / Home Phone if any) Not

Mobile Wi- Fi Not

Site ICT
Return Site Computer / Notebook Not

Timesheet Submission Not

REMARK :

Confirmed and Verified Employee IR/HR Dept

Name : MOHD AZMIN BIN MOHD ZAIN Name :

Designation : DEPUTY SECURITY MANAGER Designation :
Date : 13 JANUARY 2018 Date :

**This Form is to be returned to Site IR/HR Department duly completed prior to/on the last day of work**