PT KOMIPO PEMBANGKITAN JAWA BALI

APPLICATION FORM OF OVERTIME

Herewith, We instruct the employee(s) to overtime as follows : No 1 2 Name Rusendra Panji Ponang K Nuzul Satrianto Position Senior Engineer Yunior Engineer Date July, 03,2011 July, 03,2011 Time begins finish 8 AM 8 AM 5 PM 5 PM

Detail of job description : Indication Earthing Switch repair ( Diameter 3 )

Objective : GIS 500 KV

Reason : Important

Result of works : Understand the improvement of Earthing Switch in GIS 500 V

Notes:

Person who assign the overtime (Manager of Division) : N a m e : Kim, Ki Do Date : July, 01, 2011 Division : Electrical Division Verified and calculated by Human Resources Division : N a m e : Rohani Date : July, 01, 2011 Position : HR & Adm Leader Accepted by Finance & Admin Division : N a m e : Adrian Date : July, 01, 2011 Position : FA Leader *) Remarks : Supply of meal and transport Reimbursement (attached of evident)

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