LINE /DEVICE RECEIVED FORM

09- HRD-GS-FR-09 Line - Device Received Form

Form Number: 2025/TS/QA/LI/057

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Employee ID(Required)

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Employee Name(Required)

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Position Description(Required)

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Phone Number(Required)

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Department(Required)

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CEO Office Section(Required)

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EM Section(Required)

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Operations Section(Required)

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HR , ADMIN & IT Section(Required)

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HSE Section(Required)

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Finance Section(Required)

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TS Section(Required)

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COD Section(Required)

Date(Required)

Receipt of the(Required)

Sim Card

Mobile

Device

Other

Sim Card(Required)

Mobile(Required)

Device(Required)

Other(Required)

Specify(Required)

belongs to Petroleum Coke Industries Co. and I undertake to keep it in my custody until further notice or request to hand over again to PCIC or the expiration of the reasons to keep.

Date(Required)

Monthly Limit if any:(Required)

Used Amount if any: _(Required)

User(Required)

LINE /DEVICE RECEIVED FORM

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