Chennai Petroleum Corporation Ltd

(A group company of IndianOil)

Cauvery Basin Refinery

Panangudi, Nagapattinam 611 002

QUARTERS OCCUPYING / VACATING REPORT

Dated :___________

With reference to Allotment Order No. . I have occupied

Quarters No. on . At the time of occupation, the electricity meter reading
was ______.

I have vacated the Quarters No: , on on transfer to CPCL Manali

Refinery. The key of the same in duplicate was handed over to Township / Guest
House office.

At the time of occupation, the electricity meter reading at the time of vacation was
________.

Signature: ____________________

Name : ____________________

Designation : __________________

PR No. : ____________________

Dept. : ____________________

Location : CPCL CBR

Copies to:-

1.Personnel Dept., Manali

2.P & A Dept. CBR