INTEGRATED MANAGEMENT SYSTEM FORMAT

LMS BASE GATE PASS

Vehicle No: 83601 Name of the driver: YASIN

Company: KFS Contact no. of the driver:

Date: 07/05/2024 Time in: Time out: 17:10

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: NANANG SOPIUDIN Sign: Richard Perez

Sl. Name of crew Designation Vessel name Reason for Exit

No.
1. JOEY DELIMA LAUSA MASTER BARAG - 1 SIGN OFF
2.
3.
4.
5.
6.
7.
8.
9.
10.

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. Sachu Siby / Tech Asst / TECHNICAL
Sign Name & Position: Sign:

Sl. Item Details Quantity Vessel name Reason for material out
No.

1.
2.
3.
4.

C. Acknowledgement:
Verified by (Security):
Name of Base Security Personnel Signature Time
VIPIN V NAIR 17.30
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