(ADMIN/VEH 2)

VEHICLE SERVICE / REPAIR REQUISITION FORM

Company
Department
Location

PART A - TO BE COMPLETED BY STAFF

Staff Name

Details of the Vehicle

Vehicle Regn No Make / Model

Last Service Date Last Service Mileage

Before After
1) Speedometer reading km km

2) Fuel tank indicator E 1/4 1/2 3/4 F E 1/4 1/2 3/4 F

Details of service / repair required :

(Please mark 'X' in the appropriate box and use additional papers if space provided is insufficient)

X Normal / routine service Major (estimated above RM3,000.00)

1) 4)
2)
3)

Requested by Approved as per DAL

Name Name
Date Date

PART B - TO BE COMPLETED BY ADMIN SECTION - (REQUISITION FOR APPROVAL FOR MAJOR REPAIR)

Workshop Quoted Price (RM)

1)

2)

3)

Recommendation

Recommended by Approved as per DAL

Name Name
Date Date

PART C - TO BE COMPLETED BY ADMINISTRATION SECTION - (AFTER SERVICE)

Workshop
Cost of repair Invoice No & Date

Date sent for service / repairs Date returned

Signature Name Date

PART D - VERIFICATION UPON RECEIPT OF VEHICLE AFTER SERVICE / REPAIR

Vehicle's Sender (Please tick) User (Please tick)

Satisfied Satisfied
Not satisfied Not satisfied

Remarks Remarks

Signature & Date Signature & Date

Note: Request for vehicle service / repair must be submitted to Administration Section not later than one week before due date.