Company or Property Name: [Company / Property Name]
Location Address: [Address]
Form Date: [Date]
Reference Number: [Reference Number, if applicable]
1. Person Removing Property
Full Name: [Full Name]
Department or Company: [Department / Company Name, if applicable]
Phone Number: [Phone Number]
Email Address: [Email Address]
2. Removal Details
Date of Removal: [Date]
Time of Removal: [Time]
Location or Area: [Office / Unit / Warehouse / Room / Other]
Reason for Removal:
☐ return of company property
☐ transfer to another location
☐ disposal or scrap
☐ repair or maintenance
☐ tenant or occupant move-out
☐ other: [Describe]
3. Property Being Removed
Item 1: [Description]
Quantity: [Number]
Serial or Asset Number: [Number, if applicable]
Condition: [Condition]
Item 2: [Description]
Quantity: [Number]
Serial or Asset Number: [Number, if applicable]
Condition: [Condition]
Item 3: [Description]
Quantity: [Number]
Serial or Asset Number: [Number, if applicable]
Condition: [Condition]
Additional items, if any:
[Insert additional item details]
4. Destination or Disposition
The property removed will be:
☐ returned to owner
☐ transferred to another site
☐ sent for repair
☐ disposed of
☐ stored
☐ other: [Describe]
Destination Address or Details:
[Insert address or other details]
Approved By: [Full Name]
Title: [Job Title / Role]
Approval Date: [Date]
Approval notes, if any:
[Insert notes]
Additional notes regarding the property, condition, access, or removal process:
7. Signatures
Person Removing Property Signature: __________________________
Name: [Full Name]
Date: [Date]
Authorized Representative Signature: __________________________
Name: [Full Name]
Title: [Job Title / Role]
Date: [Date]
Witness Signature, if needed: __________________________
Name: [Full Name]
Date: [Date]