Attachment 1 Page 1 of 1
E0910-F0003-02 Procedure No E0910-P0003-02
Material Gate Pass SCY No :
Day/ Date : / Time : Location : Pass Type COR
GMR to
Owner of Goods Chandra Asri SMI Contractor/ Private
(Please tick √ ) (name)
Type of Carry-out Permanent Temporary : Vehicle No.:
(Please tick √ ) (estimated date of return)
Type of Goods : Machine,Parts, Tools/Equipment Product Samples Office Equipment PC / LAPTOP
(Please tick √ ) Industrial Wastes Grass and Domestic Waste Project Material Excess *) Refilled/replaced
Purpose :
Emergency Reason*) :
*) Fill-out in case of emergency condition only
FOR TERMPORARY COR / GMR Only
[Fill-out When returning the goods]
NO DESCRIPTION OF GOODS TOTAL UNIT
TOTAL REMAIN
RETURN (if any)
GRAND TOTAL
APPROVAL SHEET
(Based on Request Approval Matrix)
No Position Name ID No. Signature Date / Hours
1 Requestor /
2 Transporter /
3 Witness :
a). Person In Charge (User) /
b). Security /
4 SM Incharge /
5 DM / GM Incharge /
7 Security Head/ Coordinator /
VERIFICATION OF TEMPORARY COR / GMR AT THE TIME OF ESTIMATED DATE OF RETURN
APPROVAL WHEN RETURNING OF GOODS
NOT RETURNED YET
HAD BEEN RETURNED, on
date of return The Person who return the goods SM In Charge Security Coordinator