Doc. No.

FORM-PTSI-HR-SEC-051-E
PT SAIPEM INDONESIA FORM
Rev. 01 Date 09/02/21

Page 1 of 1
GOODS GATE PASS
Doc. Ref. WI-PTSI-HR-SEC-051-E

Gate Pass No.

GOODS GATE PASS

Destination PT Sasmita Inter Teknik Batam Date 27-Feb-24

Vehicle No BM 9294 RU Time 09.00 WIB

Driver's Name Jumadi Signature :

Reasons Disposal /Scrap Repair Mechanic's Consumables
Others,Pls specify
Rental Return Installation ( for Construction )
No Desription Quantity

1 DO-SIT-090-2023 1 Ls

2 DO-SIT-0102-2023 1 Ls

3 DO-SIT-0103-2023 1 Ls

4 DO-SIT-0104-2023 1 Ls

5 DO-SIT-0118-2023 1 Ls

6 DO-SIT-0163-2023 1 Ls

7 DO-SIT-0164-2023 1 Ls

8 DO-SIT-0167-2023 1 Ls

9 DO-SIT-0172-2023 1 Ls

10 DO-SIT-0179-2023 1 Ls
Property to be returned : Yes No
Remarks :
Requested By: Head Department
Name : Riyan Saputro Name

Date : 2/27/2024 Date

Signature : Signature

Warehouse/ Store Keeper Security Check

Name : Name :

Date : Date

Signature : Signature :

000000This document is the property of PT Saipem Indonesia. All rights reserved.# 2505FSaipem Classification - General Use
2