HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
RELIC MOVEMENT / TRANSFER REQUEST FORM
Form Code: HSW-F09
Request Number: ____________________________
Date of Request: ____ / ____ / ______
1. RELIC DETAILS
1.1 Relic ID Code(s):
__________________________________________
1.2 Relic Name(s):
__________________________________________
2. MOVEMENT DETAILS
2.1 From Location:
Room / Area: _____________________________
Cabinet / Case: _________________________
2.2 To Location:
Room / Area: _____________________________
Cabinet / Case: _________________________
2.3 Purpose of Movement:
[ ] Ritual / pūjā
[ ] Exhibition
[ ] Conservation / repair
[ ] Scientific testing
[ ] Cleaning / maintenance
[ ] Other: ______________________________
2.4 Planned Date and Time of Movement:
Date: ____/____/____ Time: _____________
3. PERSON REQUESTING MOVEMENT
3.1 Name: ____________________________________
3.2 Department / Role: ______________________
3.3 Signature: _____________ Date: ____/____/____
4. APPROVAL
(to be completed by department head / custodian)
4.1 Decision:
[ ] Approved
[ ] Not approved
[ ] Approved with conditions:
______________________________________
4.2 Approver Name: __________________________
4.3 Role: ___________________________________
4.4 Signature: ____________ Date: ____/____/____
5. MOVEMENT EXECUTION
5.1 Date and Time Actually Moved:
Date: ____/____/____ Time: _____________
5.2 Staff Handling the Relic (two names if possible):
Name 1: __________________ Signature: __________
Name 2: __________________ Signature: __________
5.3 Condition on Arrival at New Location:
__________________________________________
__________________________________________
Office Use Only:
Record entered into movement log by:
Name: ________________________ Date: ____/____/____
