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GIP-Badging Request 22-11-2022

This document is a request form from contractor CV. IKB for new General Identification Pass (GIP) and badges for two additional workers - Awaludin and Salahudin - to work on a drill site preparation contract. The summary includes details of the workers such as name, position, and local status. It also provides totals of original contracted workers and additional workers to date. Approval is required from HR, contract owner, and safety departments. Attachments include individual worker information sheets.

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David Ramadhan
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41 views3 pages

GIP-Badging Request 22-11-2022

This document is a request form from contractor CV. IKB for new General Identification Pass (GIP) and badges for two additional workers - Awaludin and Salahudin - to work on a drill site preparation contract. The summary includes details of the workers such as name, position, and local status. It also provides totals of original contracted workers and additional workers to date. Approval is required from HR, contract owner, and safety departments. Attachments include individual worker information sheets.

Uploaded by

David Ramadhan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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NEW/EXTENTION

REQUEST FORM G.I.P AND BADGING


CONTRACTOR TO COMPLETE

CONTRACTOR NAME : CV. IKB


CONTRACT NUMBER : STM-CN22-017-C
CONTRACT DESCRIPTION : DRILL SITE PROPARATION
REQUEST DATE : 22-11-2022
CONTRACT DURATION START DATE : 26-Oct-22
EXPIRY DATE : 25-Oct-23

REMARK (SEE NOTE)


NAME
NO. BADGE POSITION
(Print Full Name) Previous
(1) (2) (3)
Bagde
1 Awaludin Helper Person Local

2 Salahudin Helper Person Local


CONTRACTOR TO COMPLETE

Summary of total manpower to date


Original contract :
Additional (Last request) : 62
Additional (This request) : 2
Total to date : 64
Justification :

Note :
Please mark :
1)
Subcontractor : Name of Subcontractor which supply the person
2) District (Hu'u, Dompu, Bima)
Direct Hire Local : Local
Direct Hire Outsider3): Non Local as item 2 above
The contractor shall provide justification when request GIP/Badging for Manpower replacement and shall attach
Contract Instruction or Contract Variation for each badging/GIP request.

THE CONTRACTOR MUST :


1. Attached the copy of ID card (Kartu Tanda Penduduk) for each person you proposed
2. Submit the form as attached (Attachment 1 - Manpower Information Data) - for new employee
3. Attached Copy of Medical Fit Certificate issued by valid institution
4. Contractor should submit REQUEST FORM of GIP AND BADGING, at least 6-working-days
prior to GIP being conducted

Proposed by, Approved by: Approved by: Approved by:

Contractor HR Dept Contract Owner Safety Dept


ATTACHMENT 1
MANPOWER DATA INFORMATION

No. badge :
Contractor Name : CV. IKB
Full Name / Nama Lengkap : Awaludin

Jl. Lintas Lakey, Desa Daha Kec. Hu'u, Kab. Dompu


Address / Alamat :
Local / Non Local : Local
Home Phone / Mobile / No. HP : 083854010222
State / Bangsa : Indonesia
Place/Date of Birth ( D.O.H ) / T.T. Lahir : Daha, 03-04-1996
Date of Hire / Tanggal Diterima :
Point of Hire (POH) / Tempat Diterima :
Marital Status / Status Pernikahan : Single
Gender ( L/P ) : L
ID Number / No KTP : 5205030304960002
Position / Posisi : Helper
Departement : Konstruksi
Education / Pendidikan : SMA
Emergency Contact :

Other Information :

Proposed By, Approved By,

Contractor Contract Owner


Name : Name :
B/N : B/N :
ATTACHMENT 1
MANPOWER DATA INFORMATION

No. badge :
Contractor Name : CV. IKB
Full Name / Nama Lengkap : Salahudin

Jl. Lintas Lakey, Desa Marada Kec. Hu'u, Kab. Dompu


Address / Alamat :
Local / Non Local : Local
Home Phone / Mobile / No. HP : 085337661280
State / Bangsa : Indonesia
Place/Date of Birth ( D.O.H ) / T.T. Lahir : Hu'u, 05-06-1998
Date of Hire / Tanggal Diterima :
Point of Hire (POH) / Tempat Diterima :
Marital Status / Status Pernikahan : Kawin
Gender ( L/P ) : L
ID Number / No KTP : 5205030505980002
Position / Posisi : Helper
Departement : Konstruksi
Education / Pendidikan : SMA
Emergency Contact :

Other Information :

Proposed By, Approved By,

Contractor Contract Owner


Name : Name :
B/N : B/N :

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