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Solutions LLC
Equiment Borrow Request Form
This form should be completed when requesting Jeem Solutions LLC assets and equipment to be used outside the premises of the company for specific company usage and special project work. The employee take full responsibility that if any damages/theft occurs during this period under his or her possession with the company equipment, he or she shall reimburse the amount of the equipment according to the market value. The Employee shall retain in confidence any and all confidential information, including, but not limited to, the Company or its Clients processing, codes, programs, design, art work, graphics, engineering, marketing, merchandising and selling which concern the Company and/or its clients except information which is ascertainable or obtained from public information or received by the Employee subsequent to the termination of the Employee's services by the Company from a third party not employed or otherwise affiliated with the Company or its Client. The employee also acknowledges that they do not make or publish any statements about the Company which are incorrect or untrue or adverse to the Companys interests or are misleading and which may have the effect of damaging the reputation / esteem of the Company or its employees in any way. The Company also acknowledges and assures that it would abide by the same principle and would not wish to damage the Employee reputation.

The form should be completed, signed and forwarded to Jeem Solutions LLC office, in person, by post or by scanning and sending to misterikhan@gmail.com.

1. Details of User needing equipment(s) and accessories

(if more than one equipment is needed, please list the others in section 4 below) First Name Last Name Equipment Type Model Number Serial Number Accessories

2. Contact Details
(Please enter an email address or phone number so that we can contact you if we need any further information or when the access has been granted). Telephone Number Email Address Employee Address

Equipment Request Form.docx Page 1 of 2

Jeem Solutions LLC

Equiment Borrow Request Form 3. Equipment Required (please list below all equipment and accessories required)

Equipment Type
Model Number Serial Number Accessories

4. Authorisation N.B. Unsigned forms will not be processed

Requestor Name (print name): Signature: (ink or digitised) Request Date:

Authorisation signature required here

5. To be completed by Jeem Solutions Authorized Person:

User Matrix updated Access Granted by Jeem Solutions Authorized Person

Name: Signed: Date:

Equipment Request Form.docx

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