TO WHOM IT MAY CONCERN

CAR REQUEST FROM CAR POOL

TO

: General Services Department

Employee/Requestor

Position

Employee No.

Department / Section

DESTINATION

PLEASE CHECK YOUR PREFERENCE

Within Jubail only

If out of Jubail, please specify

DATE2010201020102010

TIMEFromAM PMTo AM PMFromAM PMTo AM PM

PURPOSE :

(

MOTOR VEHICLE CONDITION

Description

CAR MILEAGE

KILOMETER READINGS

Current (Before Travel) Most Recent (After Travel)Difference

Requested by_________________Signature Over Printed Name

Noted by_________________Signature Over Printed NameDepartment/Section HeadApprove by_________________Mr. Khalid Al-Khater

Administration Superintendent

FOR GS USE ONLY:

Remarks upon car is returned to the car Pool (if any)