INTEGRATED MANAGEMENT SYSTEM FORMAT

LMS BASE GATE PASS

Vehicle No: - Name of the driver: - TAXI
62802

Company: KHALID FARAJ SHIPPING Contact no. of the driver: -

Date: 10.04.2024 Time in: - 11.45 Time out: 05:00 AM

A. GATE PASS ISSUED FOR CREW EXIT:

A.1 Master’s approval (For vsl crew ) A.2 LMS Base TSO Approval: (Digital sign is accepted)
A.1.a. Crewing Dept. Approval: (Applicable for Master) Name: Sign:
Name: Sign: Richard Perez

Sl. Name of crew Designation Vessel name Reason for Exit

No.
1. ARJUN PRASAD AB BUSHRA BUY PERSONAL ITEMS
2.
3.
4.
5.

B. GATE PASS ISSUED FOR MATERIAL:

B.1 Dept. Approval: (Digital sign is accepted)

B.2 LMS Base TSO Approval: (Digital sign is accepted)
Name/Position/Dept. Sign
Name & Position: Sign:

Sl. Item Details Quantity Vessel name Reason for material out
No.
1.
2.
3.
4.
5.
6.
7.
8.
C. Acknowledgement:
Verified by (Security):
Name of Base Security Personnel Signature Time
05.15
VIPIN V NAIR
Note:
 Exit is not allowed without approval.  Approving party shall cross all empty columns.
 In case of any security issues noticed exit shall be denied even approval is available.

TSO- Terminal Security Officer, LMS -Liwa Marine Services

Document No: KFS/IMSF/01/ LMS Base Gate pass Revision: 00/ Issue Date: 04-February-2022 Page 1 of 1