Security Regulation Form
Check box for the request
Request Date March 11, 2023
VISITOR'S ENTRY
Company FS phils
B STORAGE DEVICE Company Address MABIGA, MABALACAT
Company Contact No
ENTRY/EXIT MATERIAL
ENTRY/EXIT
Accomplish the information in the appropriate letter
Date of Visit:
A From: To : Classification Visiting Place
Visitor's Name
1) Vendor Utility Building
z) Technical Support Incoming Warehouse /IQC
s) Others Samsung Warehouse
4) VIP Production
Free Pass 3’° Floor
Reminder: Plate No : Others
• Compare representative shall be responsible to guide & monitor their
visitors while inside the visiting place within the facility. Purpose:
• Visitors are not allowed fa enter other places other than the approved Driver W
visiting place in this form
• Access to Business Center is subject for HRGA Team Head Approval
B Bring- IN/OUT Date (d/m/y) Type of Device Details
Time (AM / PM ) Storage Device
Purpose
Laptop
Document
Permit Validity (d/m/y) Others
Reminder :
• Process this request one (1) day before the scheduled visit
• Attach reference permit for the Bring Out items as proof of ownership and previous transaction
Date of Pass 03/09/2023 03/31/2023 (d/m/y) CARGO PACKAGING
C Transaction Details
(Description) box / pc / etc
Shipper
/Truckin9 .
Pull Out
0 Return to Supplier Recipient Company FS PHIL. PLEASE
O Disposal Address
O Items for Repair MABIGA, MABALACAT
SEE
É Return Date / /
O Items for fabrication- Return
» Return Date / / Driver Ronnie Canilao Dizon ATTACHMENT
O Items for calibration Drivers D16-94-098132
• Return Date / /
0 Excess Construction Materials License Plate CAX-3734
O Others
Number
Personal Property
Others: Purpose :
Security Verification: Return of Item YES NO Security In-charge Date Verified / /
Prepared By Noted By (Requestor Team Head) | Approved By ( HRGA Team Head/SCO)
Christian Joy De Guzman
Signature over Printed Name Signature over Printed Name Signature over Printed Name
Position : SAFETY OFFICER Position Position
Date: 03/11/2023 Date Date
SMS-011-000
KIC-00012-011 EFF: 04/30/2018
