DEBIT NOTE
Painterior Protective System LLP DATE :
Film City, Goregaon East
Mumbai MH 400065
NAME : __________________________
CONTRACTOR NAME : ________________________
LOCATION : _________________________
SAFETY VIOLATION
SR
NO DESCRIPTION AMOUNT
TOTAL
1st WARNING 2ndDEBIT 3rdDISMISSAL
SAFET PROJECT
PROJECT SITE ENGINEER
OFFICER IN-CHARGE
Name-
Sign-
•This debit has been issued after giving 1st warning to the responsible person.
• If worker found 3rd time for the same the worker will be dismissal from the site.
• The above mentioned amount will be debited from contractor’s monthly bill.