MATERIAL EXIT PASS

Date: Pass daily progressive number:

Applicant full name: Applicant Company:

Driver full name: Driver Company:

Driver ID number: Vehicle Plate number:

SERIAL NUMBER - SECU-RITY

ITEM MATERIAL / EQUIPMENT / ITEM / DESCRIPTION Q.TY/ UNIT
IDENTIFICATION DETAILS CHECK

10

PURPOSE OF REMOVING THE MATERIAL / EQUIPMENT / ITEM

Trash removal Scrap sale Return to supplier Reparation

Other (explain)
DESTINATION

(Fill with complete destination)

APPLICANT SIGNATURE DRIVER SIGNATURE

AUTHORIZATION

Name and surname of authorizer Role of authorizer Signature of authorizer

CHECKED BY SECURITY

Security Officer:
 MATERIAL EXIT PASS - ‫ﺳﻤﺎح ﻣﻮاد ﺑﺎﻟﺨﺮوج‬
‫ ﺗﺎرﯾﺦ‬/ Date: Pass daily progressive number:
‫اﻟﻌدد اﻟﺗدرﯾﺟﻲ ﻟﻠﻣرور اﻟﯾوﻣﻲ‬

Applicant full name: Applicant Company:

‫اﺳم ﻣﻘدم اﻟطﻠب ﺑﺎﻟﻛﺎﻣل‬ ‫اﺳم اﻟﺷرﻛﺔ اﻟﻣﺗﻘدﻣﺔ‬

Driver full name: Driver Company:

‫اﺳم اﻟﺳﺎﺋﻖ‬ ‫اﺳم اﻟﺷرﻛﺔ اﻟﺗﺎﺑﻌﺔ اﻟﺳﺎﺋﻖ‬

Driver ID number: Vehicle Plate number:

‫رﻗم ھوﯾﺔ اﻟﺳﺎﺋﻖ‬ ‫رﻗم اﻟﻠوﺣﺔ اﻟﺳﯾﺎرة‬

SERIAL NUMBER - SECU-RITY

ITEM MATERIAL / EQUIPMENT / ITEM / DESCRIPTION Q.TY/ UNIT
IDENTIFICATION DETAILS CHECK

‫اﻟرﻗم‬ ‫ اﻟوﺻف‬/ ‫ اﻟﺑﻧد‬/ ‫ اﻟﻣﻌدات‬/ ‫اﻟﻣواد‬ ‫ ﺗﻔﺎﺻﯾل اﻟﺗﻌرﯾف‬- ‫اﻟرﻗم اﻟﺗﺳﻠﺳﻠﻲ‬ ‫ ﻛﻣﯾﺔ‬/ ‫وﺣدة‬ ‫ﻓﺣص اﻷﻣن‬

10

PURPOSE OF REMOVING THE MATERIAL / EQUIPMENT / ITEM ‫ اﻟﺑﻧد‬/ ‫ اﻟﻣﻌدات‬/ ‫اﻟﻐرض ﻣن إزاﻟﺔ اﻟﻣواد‬

‫ ﻧزع اﻟﻧﻔﺎﯾﺎت‬/ Trash removal ‫ ﺑﯾﻊ اﻟﺧردة‬/ Scrap sale ‫ اﻟﻌودة إﻟﻰ اﻟﻣورد‬/ Return to supplier ‫ ﺗﻌوﯾض‬/ Reparation

‫ اﺧرى‬/ Other (explain)

DESTINATION ‫اﻟوﺟﮭﺔ‬

(Fill with complete destination)

APPLICANT SIGNATURE ‫ﺗوﻗﯾﻊ اﻟﻣﺗﻘدم‬ DRIVER SIGNATURE ‫ﺗوﻗﯾﻊ اﻟﺳﺎﺋﻖ‬

AUTHORIZATION ‫ﺗﻔوﯾض‬

Name and surname of authorizer ‫اﺳم وﻟﻘب اﻟﻣﺧول‬ Role of authorizer ‫دور اﻟﻣﺧول‬ Signature of authorizer ‫ﺗوﻗﯾﻊ اﻟﻣﺧول‬

CHECKED BY SECURITY ‫ﺗم ﻓﺣﺻﮭﺎ ﻣن ﻗﺑل اﻷﻣن‬

Security Officer:
‫رﺟل اﻷﻣن‬