FAS Sample Kalamandir Besant Road

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ANNEXURE-A

FAS REQUISITION FORMAT


This Form should be filled in all respects before the same is forwarded to NO

Name of the Account

Location

FAS request Originating Location (our Branch Town)

Contact Person who has send request

Contact #

FE-MAP 2 kg

FAS to be done for which Products (Tick Appropriate Boxes)


FE-MAP 6 kg

Foam

Details of amount collected for upcountry FAS Cheque #


Addresses of the location with contact Person's Name & Contact # where the FAS needs to be
Contact Person
done
CHPS Launch
6 Lts er 9kg

CA SD -WL

Water ES

Date Amt
Contact Person Contact #
FIRE AUDIT SURVEY REPORT
NAME OF ACCOUNT: SAI RETAIL (INDIA) PVT LTD

ADDRESS: Besant Road Vijayawada - 520002

SURVEY DONE IN THE PRESENCE OF MR. Satyanarayana


DATE OF SURVEY: 12/06/2023
Area of Survey RECOMMENDED PRODUCT
Sr. No
(Provide Details Floor Wise) Product Brand Capacity Qty Installed Year Warranty Upto Status Remark
1 Electrical Panel MAP90 Powder Automatic CEASEFIRE 10kg 1 Mar-19 Mar-22 Expired Refill
2 Server room HCFC 123 Gas CEASEFIRE 2kg 1 Mar-19 Mar-24 GOOD
3 Electrical Panel MAP90 Powder CEASEFIRE 2Kg 1 Mar-19 Mar-24 GOOD
4 Genset Room MAP90 Powder CEASEFIRE 4Kg 1 6/1/2019 6/1/2024 GOOD
5 2nd Floor MAP90 Powder CEASEFIRE 6Kg 1 6/1/2019 6/1/2024 GOOD
6 1st floor MAP90 Powder CEASEFIRE 6Kg 1 6/1/2019 6/1/2024 GOOD
7 Ground Floor MAP90 Powder CEASEFIRE 2Kg 1 Feb-21 Feb-27 GOOD

Summary
Product Qty Value
MAP90 Powder 6kg 2
MAP90 Powder 4kg 1
MAP90 Powder 2kg 2
MAP90 Powder 10kg CM automatic 1
HCFC 123 Gas Clean Agent 2kg 1

Total Value 7

Signature of Ceasefire Representative P Ramesh E14778, 9390487406 Signature of the Client's Representative with Rubber stamp
FAS- to be conducted at (Place)

FAS Request
send to NO
Sr No Name OF Client (Date) Door No / Street No/ Road Building Name City State Contact Person Local Contact No
FAS
Done On FAS Despatch Detail In Case FAS not allowed to be done
Request Hard
Branch who's Regional In send to Send To copy/ His
Any Specefic Guidelines for responsible for Charge for Co Branch NO/ Soft Courier Name of the Contact
FAS FAS ordination (Date) Date Branch Copy Date Name POD No Person # Reason for Refusal
Remarks

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