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DEPARTMENT: DATE PREPARED:
OPERATIONS abe
EMPLOYEE'S NAME: ‘CONTROLNO.
RAIZEL MARIE BATINO / STORE OPERATIONS TRAINR,
Te
DATE ISSUED av DESCRIPTION ‘VALUE cost oaTE REMARKS
(Sarl Nooler Modu)
‘SAMSUNG GALAXY A13
MODEL SN-A135F/DS- ROM 128GB, RAM 4GB
saeepriosesiny 2: 9547291266073
WITH CHARGER, COLOR: BLAB.
SN: RRETPORNZIO. WITH CHARGER
sy sate Seen _fplyes ame) crow at ave rece the comsay pope ide st. dean a my response
Re Sa or en not nln, aged or tere renderedunrabe osreb xcept through coral wes ane
understand hate my reepenstity to etumthe above desrbe property any substtuonhreplacement which Imayrecaveuren the ae of my employment and
tne ener sao seven gar dedton of fl vlue or replacement cot rm my paycheck, fina or other, for each Rem not returned
lauthoted Ousted _ueld {companys Nome) to deduct for any unretured damaged propery Nothing In this autora shal be construed to
lait the atwilmpioymntrestnsip mse and (Company's Name)
Acknowledged and Reeve a fi wang
Prepared
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«acknowledge thet Ihave received the company property indicated above. lunderstand that itis my responsibility
to keop the sbove described property secure £0 itis not lost, stolen, damaged or otherwise rendered unusable or
serviceable except through normal wear and tear, I understand that it ls my responaibilty to return the above
described property or ny subsitution/replacement which I may recelva upon the end of my ermployment and that
the fllure to do eo will result in deduction ofits fair value or replacement cost from my paycheck, final or otherwise,
for each item not retumed. | authorized Great Quality AA Mart Ine. to dechct for any unreturmed or darnaged
7 Property. Nothing in this authorization shall be construed to limit the at-will employment relationship myself and
Great Quality AA Mart Inc.
Signature over printed name
“Agfhin and Asset Supervisor
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