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LEASED CAR

PT AstraZeneca Indonesia REQUEST FORM


The detail of the Request as follows:

Employee Name :
Employee ID :
Position :
Department :
Hiring Date :
I propose for
replacement car / request for new car *)
/ cash allowance **)
NEW CAR
Car make :
Color :

REPLACEMENT CAR
Car make :
Color :
Plate number :
Used since :

*) Choose one from the option


**) Cash Allowance: In line with cash allowance & e-toll card policy. By choosing cash allowance, I agree that I will never
request for a leased car in the future, except if I move to a sales role then I must use a leased car, in line with the policy
for sales roles. START DATE for Cash Allowance: …………………………………………….. (To be filled by
PURCHASING & submitted to HRBP).

Date:
Requested & Agreed by,

SIGNATURE OF APPROVAL
Date: Date: Date: Date:
Approved by, Approved by, Approved by, Approved by,

Department Head Head of HR Procurement Manager Head of Finance


Note:
After all approvals are completed, Department administrator prepares PR and sends to Purchasing. For Cash Allowance Request,
Purchasing will inform HRBP the START DATE for the allowance for payment process. The first payment maybe pro-rated,
depending on the start date.

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