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<title>ใบขออนุญาตใช้รถยนต์กลาง</title>
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<p><strong><font color="#000000" size="6">ใบอนุญาตใช้รถยนต์ส่วนกลาง</font></strong></p>
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<td><font size="4">เลขที่</font></td>
<td><font size="4">7468</font></td>
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<td height="24" colspan="10"><div align="center"><font color="#000000" size="4"><strong><font size="5">โรงพยาบาลสัตหีบ
กม.10 สำนักงานสาธารณสุขจังหวัดชลบุรี</font><font face="Angsana New"></strong></font></div></td>
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<td height="16" colspan="10"> <p align="center"><font color="#000000" size="4.5" face="Angsana New">12/04/2549</font></p></td>
<td height="16"><font size="4">เวลา</font></td>
<td height="16"><font color="#000000" size="4" face="Angsana New">13.33น.</font></td>
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<td width="9"> </td>
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<p><font size="3">เรียน </font></p>
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<td height="26" colspan="3"><font size="3">ผู้อำนวยการโรงพยาบาลสัตหีบกม.10
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<td width="68" height="26"><font size="3"> </font></td>
<td width="37" height="26"><font size="3"> </font></td>
<td height="26"><font size="3"> </font></td>
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<td height="8"><font size="3">ข้าพเจ้า </font></td>
<td width="79" height="8"><font color="#000000" size="3" face="Angsana New">ผ่องใส
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<td colspan="2"><font size="3">เจนศุภการ</font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td width="3"> </td>
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<td height="25" colspan="2"><font size="3">ขออนุญาตใช้รถยนต์ </font></td>
<td height="25" colspan="2"><font color="#000000" size="3" face="Angsana New">ไป
สสจ.ชลบุรี</font></td>
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<td height="25"><font size="3"> </font></td>
<td height="25"><font size="3"> </font></td>
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<td height="8"><font size="3" face="Angsana New">เพื่อ</font></td>
<td height="8"><font size="3" face="Angsana New">ประชุม HNQA</font></td>
<td height="8" colspan="2"><font size="3"> </font></td>
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<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
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<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3">จำนวน</font></td>
<td height="8"><font size="3">3 คน</font></td>
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<td height="16"><font size="3">ตั้งแต่วันท<font color="#000000" face="Angsana New">ี่</font></font></td>
<td height="16"><font size="3">17/04/2549</font></td>
<td width="62" height="16"><font size="3">เวลา</font></td>
<td width="81"><font size="3">07.45<font color="#000000" face="Angsana New">
น.</font></font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3">ถึงวันที่</font></td>
<td height="16"><font size="3">17/04/2549</font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3">เวลา</font></td>
<td height="16"><font size="3">17.30น.</font></td>
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<td height="16" colspan="2"><font size="3">รายชื่อผู้ร่วมใช้รถ</font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
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<td height="16"><font size="3"> </font></td>
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<p><font size="3">1.</font></p>
</div></td>
<td height="8"><font color="#000000" size="3" face="Angsana New">a</font></td>
<td height="8"><font size="3"> </font></td>
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<td height="8"><div align="center"><font color="#000000" face="Angsana New"><font size="3"></font>
</font></div></td>
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<td><font size="3">(ลงชื่อ)</font></td>
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<td><font size="3"> </font></td>
<td><font size="3"> </font></td>
<td><font size="3">(ผู้ขออนุญาต)</font></td>
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<td height="8"><font size="3">2.</font></td>
<td height="8"><font size="3">b</font></td>
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<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
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<td colspan="3"><div align="center"><font size="3">(ลงนามผู้มีอำนาจสั่งใช้รถ)
</font></div></td>
<td><font size="3"> </font></td>
<td width="3"> </td>
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<td width="52" height="16"><font size="3">3.</font></td>
<td><font color="#000000" size="3" face="Angsana New">c</font></td>
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<td><font size="3"> </font></td>
<td width="8" height="16"><div align="center"><font size="3"></font></div></td>
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<td><font size="3"> </font></td>
<td><div align="right"><font size="3">(</font></div></td>
<td colspan="2"><font size="3"> </font></td>
<td><div align="right"><font size="3">)</font></div></td>
<td><font size="3"> </font></td>
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<td height="8"><font size="3">ี่4.</font></td>
<td height="8"><font color="#000000" size="3" face="Angsana New">d</font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><font size="3"> </font></td>
<td height="8"><div align="center"><font size="3"></font></div></td>
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<td><font size="3"> </font></td>
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<td height="16"><font size="3">5.</font></td>
<td height="16"><font size="3">e</font></td>
<td height="16"><font size="3"> </font></td>
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<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
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<td height="16"><div align="center"><font size="3"></font></div></td>
<td height="16" colspan="3"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><font size="3"> </font></td>
<td height="16"><div align="center">
<p align="left"><font size="3"></font></p>
</div></td>
<td height="16"><font size="3">ทะเบียนรถ</font></td>
<td height="16"><font size="3">นค 426</font></td>
<td height="16"><font size="3">พขร.</font></td>
<td height="16"><font size="3">ชัยพร กุลบ่าง</font></td>
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<td width="3"> </td>
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<td height="26" colspan="3"><div align="left"><font size="3">วันที่ออกเดิน<font color="#000000" face="Angsana New">ทาง.....................................</font></font></div></td>
<td height="26"><font size="3">เวลา<font color="#000000" face="Angsana New">...............</font></font></td>
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<td height="26"> <div align="center">
<p align="left"><font size="3"></font></p>
</div></td>
<td height="26" colspan="2"><font size="3">วันที่กลับ..........................</font></td>
<td height="26" colspan="2"><font size="3">เวลา..............................</font></td>
<td height="26"><font size="3"> </font></td>
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<td height="16" colspan="4"><div align="left"><font size="3">เลขระยะทางก่อนออกเดินทาง..........................................</font></div></td>
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<td height="16"><div align="center">
<p align="left"><font size="3"></font></p>
</div></td>
<td height="16" colspan="4"><p><font size="3">เลขระยะทางกลับมาถึง. .....................................</font></p></td>
<td height="16"><font size="3"> </font></td>
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