APPOINTMENT OF FACILITY MANAGEMENT SERVICE PROVIDER REQUEST

ZA-HSE-F-02 Issue 3, Rev 0, Dated: 07.09.2017

DOCUMENTS REQUIRED

Service Provider Name

Plot No.

Building Owner Name

Request Type (Tick Appropriate Box)

Type Of Services In Contract(Tick Appropriate Box)

1. Owner’s Declaration Letter for Appointing Representatives (If Required)2. Facility Management Service Provider’s Valid License3. Employee Declaration Form (ZA-HSE-T-09) for Security Service only4. Copy of Fee Receipt (as per Fee Matrix)

NAME

TEL

FAX

MOBILE

EMAIL

SIGNATURE

DATE

STAMP

We hereby appoint the above Service Provider to deliver the selected services in our building

New Appointment of Service Provider Add service(s) to the appointed Service Provider (Please specify: ) Replacement of Service Provider (Name: )

Building Number

Fire Fighting and Fire Alarm ServicesVertical Transportation SystemsSecurity ServicesCleaning & House KeepingPest Control ServicesMEP SystemsWaste Management

BUILDING OWNER/REPRESENTATIVE DETAILS

NAME

TEL

FAX

MOBILE

EMAIL

SIGNATURE

DATE

STAMP

SERVICE PROVIDER DETAILS