MS-0040379_01 Rev : 0

PROJECT ASSIGNMENT FORM

Cost Center :
SAP Order Number :
FA Payment Number :
Customer Name :
Services Name :
Free Agent Name :
Expected Service date :

Assigned Service (list only items which are relevant for the Free Agent)

item no. item description Man-days Service Fee (IDR)

- Tyre Lab Supervisor

Total : 0.00
Tax : -
Total after tax: 0.00

item no. item description Transport Fee (IDR)

Total : -
Project Acquisition Confirmation: Total :

Date BS/BF Manager I hereby declare that I have not provided any
Free Agent
consulting services to this company during the
last five years, I also confirm that there are no
other conflicts of interest regarding the
performance of the audit

Service Acceptance

Herewith I, (name of contract agent), has delivered 100% of the subcontracted service
in accordance with above mentioned condition with deliverable of :

Attendance list
Time Sheet
Project Notes
Report

Free agent PT TUV Rheinland Indonesia

Name : Name :
Date : Date :

FRM-PP-01-01 rev. 4