DECLARATION

FOLLOWING ARE THE MEMBERS OF TEAM (PLANT NAME) WHO ARE WORKING IN BELOW MENTIONED DESIGNATION,
WE HAVE EXPLAINED THE MOBILE PHONE POLICY AND RESPONSIBILITY TO MY TEAM MEMBERS. THE MANAGEMENT
HAS FULL AUTHORITY TO TAKE NECESSARY DISCIPLINARY ACTION IF THEY ARE FOUND TO BE VIOLATING THE MOBILE
PHONE POLICY.

S. No. Name Reason for authorization Emp. Code Designation

SHAMIN PROCESS SETTING 2534 OPERATOR
1

10

Signature (safety officer):

Signature (Plant Engineer):

Signature (Production Supervisor):

Signature (Production Manager):