HSWAGATA BUDDHA TOOTH RELICS PRESERVATION MUSEUM
INCOMING RELIC LOAN REGISTRATION FORM
Form Code: HSW-F12
Loan Reference Number: _______________________
Date Received: ____ / ____ / ______
1. RELIC DETAILS
1.1 Temporary Relic ID Code: __________________
1.2 Relic Name / Title: ______________________
1.3 Description:
_________________________________________
_________________________________________
2. LENDING INSTITUTION / PERSON
2.1 Name of Institution / Person:
_________________________________________
2.2 Address:
_________________________________________
_________________________________________
2.3 Contact Person:
Name: _________________________________
Phone / Email: ________________________
3. LOAN AGREEMENT
3.1 Loan Agreement Number / Title:
_________________________________________
3.2 Main Loan Conditions (summary):
_________________________________________
_________________________________________
4. CONDITION ON ARRIVAL
4.1 Condition:
[ ] Excellent [ ] Good [ ] Fair [ ] Poor
4.2 Notes on Damage / Risk:
_________________________________________
_________________________________________
5. STORAGE / DISPLAY PLAN
5.1 Intended Location(s):
Storage: ________________________________
Display: ________________________________
5.2 Planned Display Dates (if any):
From: ____/____/____ To: ____/____/____
6. RETURN DETAILS (to be completed later)
6.1 Planned Return Date: ____/____/____
6.2 Actual Return Date: ____/____/____
6.3 Condition on Return:
_________________________________________
Received By (HSWAGATA):
Name: _________________________ Signature: __________
Date: ____/____/____
