LEAVE REQUEST APPLICATION FORM
COMPLETION OF THIS FORM MUST BE IN BLOCK LETTERS
Date Of Request FOR ADMIN USE ONLY
APPROVAL OF THIS LEAVE IS
NOTE VALID WITHOUT LEAVE PAYMENT FEE
Name (Last, First & Middle) Serving Military Officer Pay Grade
Date of Birth (DD/MM/YY): Relationship with deployed officer
Type of leave
Regular Emergency
Sick Others
Beneficiary's Address Duration of Leave
Beneficiary's Tel / Mobile No. Leave Charges for Duration
1 certify that the above information contained
herewith in this document is correct and | would abide and accept the given terms
and conditions herewith,
Beneficiary's Signature
Certifying Officer Signature
LIC. Williams Rose
PETITE
20211 1097: à, ui
tne AV og Pty ay à a
ROM DER Sp à 142/5900 SIND 9
ha pd apd mue ju ds
1784197957159096 ad, Sr JA da one ad LS
784198071376490 ne à,
D nou A
382 23 2000126 ba y 20001140 bo Ltn in a a ye a o hy
on 2004 Ae ann Sn
oP 459919 2006
PRN A A nn GoD Dy a as he Co le
ad LE (80000 À a A [lO JAS de oA AD Ge yl 1
D A ps) e Le D apy
Pe ne SANTE ly 2
D HAE À A LE A LAN A A a La we
BG in a no ¿SOC 90000 ) 62 Ju an
2 128 hans o ya e a ad a J
a IEA gh Mie Jo y AO as Atl py hy
as es
Go
BUREAU]
|
CERTIFICATE OF COMPLIANCE
| E OF con
|
==
ER
Conclusions of examination:
Based on the technical construction le and test resul review, the ROLL FORMING
MACHINE spectied above has bean examined and found to compl withthe essential
sally requromonts specfd in the EC Machinery Directive 2006/42/EC Tre EC
dec.araton of contri forthe ROLL FORMING MACHINE can be established by the
manufacture.
Harmonized sandarés: EN ISO 12100 2010, |
EN G0204-1:2000/AC; 2010.
EN 15094:2008,
Special Conditions: |
Special condon applet éme of ts Crta ae given in e aces appendices:
Aepend 1: Reston
Abpendu 2. BV General Cards of serio iow marino GCS Jor04)
‘This cena dlrs Que» Ventas China BeGom el ar vox cag of anyenanges n as
Signed
A
CE Technical we
Allan Zhong
Bureau Ventas Greater China, Industry and Facitics Division
Date: 24” June, 2013
Aaa ng gga et Po
ane 1 E Sea Rona Poona, Drm Chine
CALIFORN DRIVER LICENSE
CLASS C
SEND NONE
LN KEVIN
FN MICHAEL COSTNER
S NORTON AVE.
LOS ANGELES. CA, 90004-
DOB
RSTR NONE
3917
ones
SEXM HAIR 0
HGT 6"-01" WGT 110 1b
Ise
DD 25748578943936WGIRF13 7
EYES’ BRO
DRIVER LICENSE o
din 07135193 + ciassC do
M 06/27/2017 «exp 07/2412
: 008 07/24/1953
+ POUNDS
2 CYNTHIA T
le 2120 S. BURLESON BL VD. LOT 12
BURLESON TX 76028
12 Restrictions NONE saenda NONE
ge stat 5'-07" sssex F 16 Eyes HAZ
5 DD 63619780065257676744