DTS Number ‘SERVICE EQUIPMENT REQUEST FORM Requested By: Name fee / Department School Organization (f applicable) Needed: Start DateTime Venue: Purpose: Io Number Contact No Emalt (untip End DaterTime ‘note: 1 te equipment vi be used Tor egiaation, Kindly i oul a (1) Sarice Requos! Form (SRA f0 request tho use of th rgisraton systom and (2) an Event hfmation Form 0 spect the dla parang tho event Equpmert tobe borowed (incicate number of univ tbe borrowed) —untis Laptop —unvs.c0 Projector —untis. —unwis Extension cord — unt _—unit/s Remote corto unas, unas uns. ‘Note: ifthe Requester cannot receive the equipment, please endorse the person who ) (ences This isto authorze MMs. with 1D number to get the equipment listed bebo Borrowed by: ‘Signature over Pritod Name Date Taken: Te: List of equpment and accessories receives: Dtapion wih code No. Dower cord C1 Adaptor Dwrouse Lrrojector wth code No Diver cable Dower cord Dremote controtwith code No. Dexension cord with Code No ooo0o00 Returned by: ‘Sipnatuze ove Printed Name Date Retired Te: LUst of equipment and accessories returned Dtavtop with code No. Dirower cont C1 adaptor Diouse Llrrcectorwncide No Dive8 cabie Dower cons remete conte wahcode No extension Cord with Code No, ooooo ‘Note: 3 cys lead tmeis required. ‘The request {sh subject for approval, } ‘¢ the equipment isbeing borrowed on behat of the Facully o OfficeMDepartmert, the Facuty oOffce/Depariment Head's Sgratire parton should be duly signed by the Facuty or OffcerDepartmert Head, and the Requester's Srature be duly signed by the person borrowing the equoment from ITS. Inthis case, the Facuty or Offee/Departmet ofthe Requester isconsilered as the Party Responsble otherwise the Requester hmsstinerso¥ willbe considered as the Party Responsble ‘+The Patty Responsible willbe accountable for the borrowed equbmert util returned to TS ‘+The Party Responsible willbe lable for any charges related to late return, damage, or oss of equpmert borrowed from ITS. ‘© Equipment turned late wilbe subject to a fire of P50.00 per equpmert per hour. A Party Responsble wih unsettled accounts will pt be alloted te borrow any equipment untlthe overdue payment hasbeen settled ‘* is possible that damage or loss may be ‘caused by "movers" or by the representative's of the Party Responsible after check-out or before check-in ofthe Borrowed equipment from/to TS. In case this happens, the Party Responsbio willbe charged for the costs ‘* read and agree tothe Polcies and Procedures for borrowing muttmedia fequpmert posted inthe Hefpdesk webste: helpdesk dlsu edu phigudestbortowing! Conforme: Requesters Signature over Printed name Facuty or Offoe/Deparmert Head's Signature over Printed Name Date + + = This partis to be filled out by ITS staff= «== +++ +s eec eee e sees fematks