sumawa Tenure tannic NEWIETENTC? REQUEST FORM G.l.P AND BADGING E] covtmacton name ov. 1k & | SOwTRACTNUMBeR —: StH-cna2-017-¢ 5 RUST DESCRUION DDRILL SITE PROPARATION 5 ST ATE 03-12-2022 £] CONTRACT ouRarion STARTOATE: 10-May-22 EXPIRY DATE: 09-May-23 oe ee — REMARK (SEE NOTE) (Print Fall Name) Previour nee a @ o 2 [ne Stool Fiver Peron | Loca! wo 2 g 3 5 4 8 2 3 s 6 5 3 7 3 3 ‘Summary of total manpower to date Original contract Adcitonal (Last request) 4 JAditional (This request) z Total to date : os [Lbustication Note: lose monk: 1) contractor which supply the person 2)1 District (Huy, Dompu, Bima) 3) Non Local as tem 2 above “The contractor shall provie justieation wien request GIP/Badging for Manpower replacement and shall attach Contract Instruction or Contract Variation foreach badging/GIP request. ‘THE CONTRACTOR MUST : T. Attached Ene copy of 10 card (Kartu Tanda Pendudak) fr each person you proposed 2: Submit the form as attache (Attachment 1 ~ Manpower Information Data) = for new employee 5: attached Copy of Medical Fi Certicate issued by valid institution |: Contractor should submit REQUEST FORM of GIP AND BADGING, atleast €-workina days, [prior to GIP being conducted Propgsed by, Approved by ‘Approved by: Appiyed by:eo _SUMGANA TUR smn ATTACHMENT 7 MANPOWER DATA INFORMATION No. badge Contractor Name Full Name / Nama Lengkap Address / Alamat Local / Non Local Home Phone / Mobile / No. HP State / Bangsa Place/Date of Birth ( D.O.H )/T.T. Lahir Date of Hire / Tanggal Diterima Point of Hire (POH) / Tempat Diterima Marital Status / Status Pernikahan Gender (LIP ) ID Number / No KTP Position / Posisi Departement Education / Pendidikan Emergency Contact Other Information Proposed By, atragtor Name : BIN 2 Kawin + Konstruks! SMA Approved By, ee Name = ID NR BN = Gl0z21F1