r Baramutiara LEAVE REQUEST FORM Formulir Permohonan Cuti *) please circle the respective Deparment / Work Location Fromnna : “ied Jocaccounr S210 focnave HC Traveling (Accomodation) Fru nawe jrosirow Funan Hadi Imam Wahyudi = Haulng Superdsor Fevecovee wNBER wom cocaTion ra Sea saasson2 aos » [pave oF son Fagen Besson one HALFDAY LEAVE Oo Oo OUTSTANDING LEAVE, year 2022 JREMARKS / Keterangan pera Teri eae tomreemenned eee femenenr cw quer eveermie 8s ane Lewecarecont/semmicu i Miwakueave ns coe a Feo eREAK LEAVE, a ‘Cull Lapangan (Jedwal R&R) (Off day 19 November 2023 / Cull RR 20 November - 3 Desember 2023 | 4-7 Desember (AL 2023) & RSCHEDULE) JADDRESS WHILE ON LEAVE / sana’ semasscaan > [X. SemersNe. 41 RT 08 Kel an Java Sarena JFieLo |REAK ALLOWANCE NO J YES, AMOUNTING / Jum oR 100,000.00 Truniangan Cut Lepangan PREPARED OY ‘VERIFIED BY SITE ADWIN ‘VERIAED BY HR DEPARTWENT ‘APPROVED BY Diep eh aan Ste Dia oh Dopo Dsl aie, ee a ph rote Da sine) Terese en Mech a Damo GH Operation ATT le pe 3aiora 14 /fez Wu my _ Leave REQUEST SHOULD BE SUBMITTED AT LEAGT 7 (GEVEN) DAYS IN ADVANCE, Peralenan Cot Dierahian Mima 7 Teh Har Seber |. PLEASE SEE HR POLICY AND PROCEDURE NO. H-013\2019 ON OFFICIAL HOLIDAYS, Approved budget Usage up to now] Budget availble Propased amount (VAN) Ending budget balance AND LEAVE FOR FURTHER DETALS. ‘Yuk noma Len Re Stale Merge Pada Kebjsan dar Pose HR No, 3X/203 onan Cun Hab Res,= Baramutiaras TRAVEL AUTHORIZATION REQUEST = Name: itaaiaewataa Position: Hauling Supervisor Work va Department: opera aes Sungai Lin Phone Number | 0815842731 Point of Hire: | Samarinda [140623002 E Employee No: | Nik. @472031409720002 Date: 23/06/2014 Purpose: Details of Travel © Business © Medical © FieldBFeak =o Other Travelby: —‘| Class Please provide transportation & accommodation arrangement for: Entitlement: emampere «=o Bu GRERE | cuest details: (Name, Company, Purpose, Travel o Car o Eeenomy fo Guest by, Class) © Other Leave in Lieu: days Justification: Transportation det: i Date: Time: From: To: Transportation (carlairplane) eee Please mention the airways & fight no 19 112023 06.00 S.Lilin Palembang _| Car 19 112023, 08.45 Palembang _| Jakarta Pelita Air IP-311 19 112023 33.00 Jakarta Balikpapan__| Pelita Air P-602 aH (07 122023 13.30 Balikpapan_ a Gitllink QG 437, (07122023 17.10 Jakarta palembang | Citilink Qc 884 Hotel details: Hotel Name: Room Type: | Checkin date: [ Check outdate:[ Location: Travel Advance: Amount: : In words: Details of Advance: ie Remarks: ‘Approvals: ae Name Department Date ee Hadiimam W Operation 73 112023 Reviewed by (HR) | Horas ESiburian ‘Approved i)by | Dani Andriansyah ‘Approved (il) by _ | Henri Mugorobi tof2@aramutiara Work Delegation Form Nama Pemberi Delegasi Hadi Imam Wahyudi Nama Penerima Delegasi ‘Agus Pefrianto Jabatan “Hauling Supervisor Officer Level Jabatan_ Jabatan Level Jabatan Tauling taft Staff Tanggal Mulai__[: | 19 11 2023 Tanggal Berakhit (07112023 Rincian Delegasi Pekerjaan No Pekerjaan Tugas Keterangan* 1, | Hauling activity. Membuat laporan harian hauling. Koordinasi}meeting dengan kontraktor hauling setiap awal shift dan membuat MOM nya. ‘Membuat Laporan daily Report. Mengatur jalannya hauling sesuai SOP dan K3. ‘Memonitor keamanan jalannya coal hauling baik di tambang, jalan hauling, maupun di pelabuhan dan melaporkan keatasan apabila terjadi habhal yang tidak dinginkan selama 1924 jam. Berkoordinasi dengan team Mining. Berkoordinasi dengan Team RM untuk kesiapan jalan hauling Berkoordinasi dengan team External Relation PT. BMP apabila ada hambatan social dan masyarakat. Berkoordinasi dengan team SHE PT. BMP Kontrol Flagman Simpang B2 Koordinasi dengan team Port untuk kesiapan WB dan Stockpile *diisi setelah Pemberi Delegasi kembali ke tempat kerja dan melakukan evaluasi terhadap pengerjaan tugas-tugas yang, didelegasikan. Tanda Tangan | Pemberi Delegasi Penerima Delegasi Nama: Hadi Imam Wahy}di Nama: Agus Pefrianto Tanggal: 13/11/2023 Tanggal: 1/3