N V BO DNG:

CNG TY C PHN VIN THNG

T-TELECOM

CNG HA X HI CH NGHA VIT NAM

C LP T DO HNH PHC
---------------------------------

BIN BN NGHIM THU K THUT TNG TRM

(V/v : Bo dng ct anten, nh trm)
ti trm .................................................................. nm 2011)
Hm nay, ngy thng .nm 2011 ti ..i din cc bn gm:
A. n v thu bo dng: CNG TY INCOM
-ng( B ):

Chc danh

-ng (B ):

Chc danh

-ng (B ):

Chc danh

B. n v thc hin bo dng: Cng ty CP Vin thng T-Telecom

-ng :

Chc danh: .

-ng :

Chc danh: i trng bo dng

-ng :

Chc danh: Cn b k thut

-ng :

Chc danh: Cn b k thut

Cc bn cng nhau thng nht lp bin bn v vic kim tra bo dng nh k ct

anten, nh trm thng 3/2011.
a im bo dng:..............................................................................................................
Thi gian thc hin kim tra bo dng : T
.................................n ................................
Ni dung kim tra, bo dng
(Bao gm ton b kt qu thc hin chi tit theo cc ni dung cng
vic trong ph lc ... ca HBD s: ...../.....................................):
1. SN NH TRM:
Stt

Ni dung cng vic

Kt qu

......................................................................
.......

Khng t

..

Khng t

Khng t

Khng t

Ghi ch:..

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2. BO dng ct anten:
Stt

Ni dung cng vic

Kt qu

......................................................................
.......

Khng t

..

Khng t

Khng t

Khng t

Ghi ch:..

i din

i din

Bn thu bo dng

Bn thc hin bo dng

( K,ghi r h tn )

( K,ghi r h tn )

Gim st k thut

K thut vin bo dng

( K , ghi r h tn )

( K , ghi r h tn )

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