You can have this form no doubt, but it is small part of overall policy on "Allotment Company Assets to the Employees". You need to have this policy well in place. Format of "Asset Allotment Form" or in simple words "loan card" is Appendix of this policy.
If you wish to design this policy, you can click here to read my comments to similar query.
Mere having this policy is not sufficient. One more thing you need to do is proper maintenance of Fixed Asset Register (FAR). If FAR is well maintained then audit of the fixed assets becomes much easier.
Dinesh V Divekar
Beware of false knowledge; it is more dangerous than ignorance.
4th May 2012 From India, Bangalore