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I

Doc No: Dhaka Mass Transit Company


Electrical/L&E/ Limited
PTW/001
Rev:01 Contractor's Request Form
Date: 01.03.2023 (Uft and Escalator)

Iinternal PTW No (if acknowledged): Ioat~:


0 Lift
Request for: 0 Escalator
Equipment ID:
Location:

IFrom: IDate: Hrs Till: I


Date: Hrsl

Works tobe
Performed:

SL Nome Signature
1)
2)
Team Members: 3)
4)
5)
6)

All the conditions of respective Main PTWs are to be fulfilled by the undersigned

Requested By
(Contractor):
(Nome, Designation, Signature with Dote & Time)

Acknowledged By
(DMTCL):

(Name, Designation, Signature with Date & Time)

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