APPLICATION FOR SECURITY PASS

P L E A S E W R I T E / P R I N T C L E A R LY
T O AV O I D D E L AY, D O N O T L E AV E A N Y B L A N K S O N T H I S
FORM

1. PERSONAL DATA
FIRST NAME S h i n e t t e G r a c e

MIDDLE NAME M e n o r

LAST NAME d e l a C r u z

PERMANENT ADDRESS: CONTACT NOS.

Blk 67 Lot 17 Pkg 4 Phase I, Bagong Silang Caloocan City 09561243969
BIRTHDATE BIRTHPLACE GENDER CITIZENSHIP CIVIL STATUS NAME OF SPOUSE (If Married)
01-10-1984 Manila Female Filipino Married Aries dela Cruz
CONTACT PERSON IN CASE OF ADDRESS CONTACT NOS.
EMERGENCY Blk 67 Lot 17 Pkg 4 Phase I, Bagong 09104939183
Aries dela Cruz Silang Cal. City
2 .TYPE OF APPLICATION
X NEW PERSON ID NO. AGENCY / COMPANY ASTICOM I hereby certify that the above information
11305
are true and correct to the best of my
knowledge.
RENEWAL PERSON ID NO. SCHOOL (For Student Trainee)
SHINETTE GRACE M. DELA
CRUZ
OTHERS (Please Specify) DATE APPLIED
SIGNATURE OF REQUESTOR OVER
PRINTED NAME

ENDORSEMENT
Endorsing herewith Application for Security Pass of our Vendor Employee / Consultant / OJT with the following
employment-related information:
POSITION / DESIGNATION DURATION OF CONTRACT
Admin Assistant December 31, 2019
GROUP/DIVISION/DEPT/SECTION PLACE OF ASSIGNMENT(FOR TGT
Marketing INCLUDE FLOOR &WORK
STATION NO.)
23/Floor SIGNATURE OVER PRINTED NAME / ID
#
(PROPONENT or REQUISITIONER)

NOTICE
1. The SECURITY PASS is issued to Vendor Employees/Consultants/OJTS whose
duration of contract/training is at least one and a half (1 1/2) months.
2. It shall be returned to Security Office upon its expiration and/or upon the expiration of the
contract/training. Cardholder c/o the VENDOR PARTNER / AGENCY shall be charged a
Recovery Fee (Php250.00 for RFID type; Php 50.00 for laminated type) for every loss
of Security Pass. In case where the Security Pass is not returned by the at the end of
the contract/training, the Recovery Fee shall be charged to the VENDOR PARTNER /
AGENCY of the Vendor Employee. Payment shall be made thru GCash or at any Globe
Telecom cashier.
FOR SECURITY OFFICE USE ONLY RECEIVED BY: DATE DUE ON: