XLS《审验申请表》

"广州市二次供水设施保洁上岗证审验申请表",,

,,

,,

"申请单位:(盖章)联系人: "地址:邮编:联系方式: "审验用途(请选√)

1、自来水公司委托

2、物管部门委托(盖章)

3、投标

4、其它",,

,,

,,

"序号","持证人姓名","证号(上岗证/质控证/电工证)","所验证件有效日期","身份证号","持证人签名","备注" "1",,

,,

,,

"2",,

,,

,,

"3",,

,,

,,

"4",,

,,

,,

"5",,

,,

,,

"6",,

,,

,,

"7",,

,,

,,

"8",,

,,

,,

"9",,

,,

,,

"10",,

,,

,,

"11",,

,,

,,

"12",,

,,

,,

"13",,

,,

,,

"14",,

,,

,,

"15",,

,,

,,

"16" "17",,

,,

,,

"审验费用: "说明:","

1、请携带本表及上岗证、质控证、电工证、身份证原件进行审验(电工证、身份证原件交验后退回),其中需附上电工证复印件一份(带公章).

若所验证件距离有效日期少于30天的,应办理年审换证后再受理.",,

,,

, "","

2、本表每页17行,请勿自行修改表格内容,如自行对本表进行更改后不予以受理.因未取得证件原件不能完成审验的,请自行保管本表,协会不予保管.",,

,,

, "","

3、持证人签名一栏须由本人签署.受理之日起5个工作日后凭回执领取审验证明书.",,

,,

, ,,

,,

"经办人:",,

,,

,,

"受理日期:年月日",,

"回执",,

,,

,,

"领证人:领证日期:年月日",,

,,

,,

"请于5个工作日后,逢周

一、周四对外办公时间凭回执领取审验证明书.",,

,,

,,