Date

Time
Consignment No.
Jaguar Bag No.
SERVICE REPORT FORM
Section 1: Type of Collection
Cash Collection Cheque Collection Coin Collection
Section 2: Customer Information
Customer Name Indah Water Konsortium Sdn Bhd
Branches UO Langat UO Shah Alam UO Klang UTC Melaka UO S.Perai
UO Subang Jaya UO Kuala Lumpur UO N.Sembilan UTC A.Setar UO Penang
UO Gombak UTC Pudu UO Melaka UO Sg.Petani UO Taiping
UTC Ipoh UO Manjong UO Skudai UTC Johor UO Kluang
UTC Kuantan UO K.Terengganu
Section 3: Collection Information
The information given below must be filled up correctly according to the customer’s consignment details. We are We have the right to refuse
not authorised to open and double-check the contents. acceptance of damaged/torn
consignment.
Consignment Qty. (Sealed Bag No.)
Good Condition
(A) Handover Amount by the Customer (Cash & Coin) : ________________________ (by IWK) Damage
(B) Handover Amount by the Customer (Cheque) : ________________________ (by IWK)

Section 4: Service Provider Acceptance – (By JA Secure)
I now confirm and verified to collect the assigned’s consignment in good
condition. I authorise the details in Section 3 are correct, and the
shipment is sealed adequately by the customer until the handover to the
authorised recipient. All information referred to the bank-in voucher
provided by the customer without counting its amount. I hereby confirm
the information provided above is true, accurate and complete
Name
Section 4: Customer’s Authorisation – (By IWK)
I verify the information in Sections 1, 2, 3, and 4 has been filled correctly by
the service provider. We understand and agree with all appropriate
preventive measures. All our consignments are appropriately packed into the
sealed bag and labelled correctly by our authorised personnel. I confirmed
and ensured the amount stated on the bank-in voucher/handing-over form
follows the amount of the physical goods inside the sealed bag and is handed
over to our authorised service provider until it reaches the recipient. For any
discrepancies, I shall be dealt directly with the recipient. I hereby confirm the
information provided above is true, accurate and complete

IC No./ Name
Staff No.

IC No./
Staff No.

------------------------------------------------------------------------------- ---------------------------------------------------------------------------------
Signature & Stamp Signature & Stamp

Date Time Date Time

Day Month Year Hour Min Day Month Year Hour Min

Section 5: Authorise Recipient (Bank Use Only)

I verify to receive the sealed bag consignment with its content in good Bank Official Stamp:
condition. I hereby confirm the information provided above is true,
accurate and complete.

Name

------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------
Authorised Signature
Stamp and Location
Date Time
Day Month Year Hour Min