Effective Date: Document No.

:
PT. AMARTA INDONESIA MAKMUR
Jl. Kramat Raya No.5E Jakarta Pusat 10450
Phone: (021) 3909392, 3157665, 3161184
Fax: (021) 3155135

Maret, 2013 SHE-FM-18

SISTEM MANAJEMEN KESELAMATAN, KESEHATAN KERJA & Controlled Copy Sheet No.:
No.:
LINDUNGAN LINGKUNGAN 1 of 1

Title : ACKNOWLEDGEMENT MEMO

To: ______________________

Date: ______________________

RE: COMPANY IN-HOUSE SAFETY RULES AND REGULATIONS

I, (Name) H. KARDITO (Appointment) President Director of (Name of Company)

AMARTA INDONESIA MAKMUR, PT, acknowledge receipt and understand your
company’s In-House Safety Rules and Regulations. I will ensure that the rules and
regulations are briefed to my workers for their observance and compliance.

I will ensure that my workers and sub-contractors under my charge give their full co-
operation to the company in the interest of safety and well-being of all persons
working in this company.

PT. AMARTA INDONESIA MAKMUR

H. KARDITO.
President Director