Doc. No.

FORM-SIKB-HR-045-E
PT. Saipem Indonesia (Karimun Branch) FORM Rev. 01 Date 14/04/14
Page 1 of 1
LEAVE REQUEST FORM Doc. Ref. WI-SIKB-HR-003-E

Employee Name : Badge ID :

Position : Dept./Project :

Leave Start Date Leave End Date No. of Days

Type of Leave (Plese check where appropriate)

Annual Leave Baptism Leave: 2 days

Cuti tahunan Cuti baptis: 2 hari
Off-in-lieu Child Circumcision Leave: 2 days
Cuti pengganti lembur Cuti khitanan: 2 hari
Marriage of Employee Leave: 3 days Compassionate Leave - Immediate Family: 2 days
Cuti nikah: 3 hari Cuti berduka - Keluarga inti: 2 hari
Marriage of Daughter or Son Leave: 2 days Compassionate Leave - Sibling: 1 day
Cuti nikah - Anak kandung: 2 hari Cuti berduka - Saudara kandung: 1 hari
Marriage of Sibling Leave: 1 day Unpaid Leave
Cuti nikah - Saudara kandung: 1 hari Cuti yang tidak di bayar
Paternity Leave: 2 days Sick Leave
Cuti bila istri dari karyawan melahirkan: 2 hari Cuti sakit
Maternity Leave: 3 months Other (Reasons) Leave
Cuti karyawan perempuan melahirkan: 3 bulan Cuti lain

REMARKS (By the Employee or Supervisor)

REMARKS (By Human Resource Department)

Requested by: Acknowledged by: Authorized by: Approved by:

Employee Immediate Supervisor Head of Department HR Manager

Signature Signature Signature Signature

Name Name Name Name

Date Date Date Date

All printed copies are considered uncontrolled and the validity of this document shall be verified via DMS SharePoint before use.