REQUEST FOR MATERIAL SAMPLE APPROVAL (MSA)

CONTRACT NO. :

CON/006/VI/201
3-1106 2013

SAMPLE NO

:-

DATE

THE CONTRACTOR :

PACKAGE

: CP 104 & 105

COST CENTER NO :

DATE
SOWJ

THE ENGINEER :

December 13, 2016

JMCMC

MATERIAL DESCRIPTION: Daiken Ceilings (Excel Tone MR)

PROPOSED LOCATION : CP 104 & 105
NAME AND ADDRESS OF MANUFACTURER/SUPPLIER:
Daiken Corporation
Mid Plaza 1, Jl. Jend. Sudirman, RT.10/RW.11, Karet Tengsin, Tanah Abang, Kota Jakarta Pusat, Daerah Khusus Ibukota Jakarta
10220
Phone: (021) 6003751
SPECIFICATION OR STANDARD TO WHICH THE MATERIAL CONFORMS :
-

ASTM E82
JIS A 1412
JIS A 6301

DOCUMENT ATTACHED, e.g., test data, broshures, etc

-

Company Profile & Material Detail

CONTRACTORS SUBMISSION
Approval for the above-mentioned material is requested to carry out
the specified works.

ENGINEERS COMMENTS:
The material is accepted/rejected (*)

Name :
Position:

Contractors Representative
( SOWJ JV )

(JMCMC)

Date :

Date:

ENGINEERS COMMENTS:
The material is accepted/rejected (*)
With the following reason (s):

CONFIRMED BY THE EMPLOYER

The material is/is not confirmed (*)
With the following reason (s).

Name :
Position: Project Manager
(JMCMC)
Date :

Name :
Position :
(MRTJ)
Date: