Material

‫ﻧﻣوذج طﻠب‬
Transfer
Date 27/12/2020 ‫اﻟﺗﺎرﯾﺦ‬ ‫ﻧﻘل ﻣواد‬
Request Form

1- Required service Details ‫ ﺗﻔﺎﺻﯾل اﻟﺧدﻣﺔ اﻟﻣطﻠوﺑﺔ‬-1

Medical Supplies ‫ﻣﺳﺗﻠزﻣﺎت طﺑﯾﺔ‬ Pharmaceuticals ‫ﺻﯾدﻻﻧﯾﺔ‬

Industrial ‫ﺻﻧﺎﻋﯾﺔ‬ Chemicals ✔ ‫ﻛﯾﻣﯾﺎﺋﯾﺔ‬

Material Type ‫ﻧوع اﻟﻣواد اﻟﻣﻧﻘوﻟﺔ‬
Milk ‫ﺣﻠﯾب‬ Consumables ‫اﺳﺗﮭﻼﻛﯾﺔ‬

Other ,Specify ‫ ﺣددھﺎ‬، ‫أﺧرى‬

1
(................) Barrel ✔ ‫ﺑرﻣﯾل‬ (................) Pallets ‫طﺑﺎﻟﻲ‬

Container Type & (................) ‫ﻛﯾس‬ ‫ﻛرﺗون‬

Bag (................) Cartons
‫ﻧوع و ﻋدد اﻟﺣﺎوﯾﺎت‬
Number
Other ,Specify ‫ ﺣددھﺎ‬، ‫أﺧرى‬

Carrier Customer ‫اﻟﻌﻣﯾل‬ SEPCO ✔ ‫ﺳﯾﺑﻛو‬ ‫اﻟﻧﺎﻗل‬

Transfer Date 02/01/2021 ‫اﻟﺗﺎرﯾﺦ اﻟﻣطﻠوب ﻟﻠﻧﻘل‬
Truck from 16-24 Pallet ‫ طﺑﻠﯾﺔ‬24-16 ‫ﺷﺎﺣﻧﺔ ﻣن‬ Truck from 10-14 Pallet ‫ طﺑﻠﯾﺔ‬14-10 ‫ﺷﺎﺣﻧﺔ ﻣن‬

Industrial Materials ‫ﻣواد ﺻﻧﺎﻋﯾﺔ‬ Liquid Transfer Truck ✔ ‫ﺷﺎﺣﻧﺔ ﻧﻘل ﻣواد ﺳﺎﺋﻠﺔ‬
Truck Type ‫ﻧوع اﻟﺷﺎﺣﻧﺔ اﻟﻣطﻠوﺑﺔ‬
Tipper 24 m3 3‫ م‬24 ‫ﻗﻼب‬

Other ,Specify ‫ ﺣددھﺎ‬، ‫أﺧرى‬

2- Customer Information ‫ ﻣﻌﻠوﻣﺎت اﻟﻌﻣﯾل‬-2

Company Name ‫ﻣﺟﻣﻊ اﻛﺳﯾر اﻟطﺑﻲ اﻟﻌﺎم‬ ‫اﺳم اﻟﺷرﻛﺔ‬
‫ ﺟوار طرﯾق اﻟﺳﯾل‬- ‫ ﺣﻲ اﻟﺣﻣداﻧﯾﺔ‬- ‫ﺟدة‬
Address ‫اﻟﻌﻧوان‬

3- Requirements ‫ اﻟﻣﺗطﻠﺑﺎت ﻋﻠﻰ اﻟﻌﻣﯾل‬-3

1 Appropriate loading methods (equipments / labors). .(‫ ﻋﻣﺎﻟﺔ‬/ ‫ وﺳﺎﺋل ﺗﺣﻣﯾل ﻣﻧﺎﺳﺑﺔ )ﻣﻌدات‬1
‫اﻟﻣواد ﺗﻛون ﻓﻲ ﺣﺎﻟﺔ ﻣؤﻣﻧﺔ )ﺟﯾدة اﻟرﺑط واﻟﺗﻐﻠﯾف( و ﯾﻣﻛن ﻧﻘﻠﮭﺎ‬
2 The waste material is secured and easy to move. 2
.‫ﺑﺳﮭوﻟﺔ‬
3 Location information (MAP / GPS). .(‫ اﻟﻣوﻗﻊ ﺑﺎﻷﻗﻣﺎر اﻟﺻﻧﺎﻋﯾﺔ‬/ ‫ ﻣﻌﻠوﻣﺎت ﻣوﻗﻊ اﻟﺗﺣﻣﯾل )ﻛروﻛﻲ‬3
4 An approved and stamped waste material picking list. .‫ ﺑﯾﺎن وﺻف ﻣواد ﺑﺎﻟﻛﻣﯾﺎت اﻟﻣﺳﺗﻠﻣﺔ ﻣُوﻗّﻊ و ﻣﺧﺗوم‬4

4- Extra charges incurred by the customer ‫ ﺗﻛﺎﻟﯾف إﺿﺎﻓﯾﺔ ﯾﺗﺣﻣﻠﮭﺎ اﻟﻌﻣﯾل‬-4

300 SAR: Cancelling the request within 24 hours from the
1 .‫ ﺳﺎﻋﺔ ﻣن ﺗﺎرﯾﺦ اﻟﺗﺣﻣﯾل اﻟﻣﺗﻔﻖ ﻋﻠﯾﮫ‬24 ‫ إﻟﻐﺎء اﻟطﻠب ﻗﺑل‬:‫ ﷼‬300 1
agreed loading date.
500 SAR: Canceling the request in the date of loading and
2 .‫ إﻟﻐﺎء اﻟطﻠب ﻓﻲ ﯾوم اﻟﺗﺣﻣﯾل و ﻗﺑل إرﺳﺎل اﻟﺷﺎﺣﻧﺔ‬:‫ ﷼‬500 2
before sending the truck.
700 SAR: Canceling the request while the truck in the ‫ إﻟﻐﺎء اﻟطﻠب ﻓﻲ ﯾوم اﻟﺗﺣﻣﯾل ﺑﻌد وﺻول اﻟﺷﺎﺣﻧﺔ ﻟدى‬:‫ ﷼‬700
3 3
loading location. .‫اﻟﻌﻣﯾل‬
Sign &Stamp ‫ اﻟﺗوﻗﯾﻊ و اﻟﺧﺗم‬Mobile ‫ اﻟﺟوال‬Job Title ‫اﻟﻣﺳﻣﻰ اﻟوظﯾﻔﻲ‬ Name ‫اﻹﺳم‬
Person
in 0563503255 ‫ﻣدﯾر اﻟﻣﺧﺗﺑر‬ ‫اﺑوﺑﻛر ﻣﺑﺎرك ﺧﺎﻟد‬ ‫اﻟﻣﺳﺋول‬
Charge
* Any waste material not included in the agreed contract will ‫ و ﺳﯾﺗم‬،‫* ﻟن ﯾﺗم ﺗﺣﻣﯾل أي ﻣواد ﻣﺧﺎﻟﻔﺔ ﻟﺑﻧود اﻟﻌﻘد اﻟﻣﻌﺗﻣدة ﺑﯾن اﻟطرﻓﯾن‬
not be accepted, and the customer will be charged the extra ‫ﺗطﺑﯾﻖ ﺑﻧود اﻟﺗﻛﻠﻔﺔ اﻹﺿﺎﻓﯾﺔ اﻟﺗﻲ ﯾﺗﺣﻣﻠﮭﺎ اﻟﻌﻣﯾل اﻟﻣذﻛورة ﻓﻲ اﻟﻔﻘرة‬
cost mentioned in item No (3). .(3) ‫رﻗم‬
* All extra charges will be included in the invoice. .‫* ﺟﻣﯾﻊ اﻟﺗﻛﺎﻟﯾف اﻹﺿﺎﻓﯾﺔ ﺗﺿﺎف ﻋﻠﻰ ﻓﺎﺗورة اﻟﻣﻌﺎﻟﺟﺔ‬

‫م‬2018/10/01 - (1.0) ‫اﻹﺻدار‬ (11) ‫رﻗم اﻟﻧﻣوذج‬