I, ____________________________________ with Gate Pass ID # ___________, miner/leadman under

_________________ contract hereby admits that I failed to comply with the policy on required number
of days worked for the month of ________________, ______.
I was absent because - _________________________________________________________________
______________________________________________________________________________.

Through this, I hereby accept this written WARNING for failure to comply with the above policy. Also, I
hereby understand and agree that the next violations of this policy would be penalized with one (1)
month suspension then PERMANENT BLACKLISTING/BANNING.

ACCCEPTED BY: NOTED BY: ENDORSED BY: APPROVED BY :

________________ ____________________ ________________________ ___________________

Leadman or Supervisor Secretary or Safety Engineer Contractor
<-------------------------------- (Signature Over Printed Name with Date signed) ------------------------------>

__________________________________________________________

I, ____________________________________ with Gate Pass ID # ___________, miner/leadman under

_________________ contract hereby admits that I failed to comply with the policy on required number
of days worked for the month of ________________, ______.
I was absent because - _________________________________________________________________
______________________________________________________________________________.

Through this, I hereby accept this written WARNING for failure to comply with the above policy. Also, I
hereby understand and agree that the next violations of this policy would be penalized with one (1)
month suspension then PERMANENT BLACKLISTING/BANNING.

ACCCEPTED BY: NOTED BY: ENDORSED BY: APPROVED BY :

________________ ____________________ ________________________ ___________________

Leadman or Supervisor Secretary or Safety Engineer Contractor
<-------------------------------- (Signature Over Printed Name with Date signed) ------------------------------>
__________________________________________________________

I, ____________________________________ with Gate Pass ID # ___________, miner/leadman under

_________________ contract hereby admits that I failed to comply with the policy on required number
of days worked for the month of ________________, ______.
I was absent because - _________________________________________________________________
______________________________________________________________________________.

Through this, I hereby accept this written WARNING for failure to comply with the above policy. Also, I
hereby understand and agree that the next violations of this policy would be penalized with one (1)
month suspension then PERMANENT BLACKLISTING/BANNING.

ACCCEPTED BY: NOTED BY: ENDORSED BY: APPROVED BY :

________________ ____________________ ________________________ ___________________

Leadman or Supervisor Secretary or Safety Engineer Contractor
<-------------------------------- (Signature Over Printed Name with Date signed) ------------------------------>