e BERITA ACARA SERAH TERIMA GOODS / SERVICES RECEIPT NOTE MIGO (SES) No. 5017489816 GL&.WBS No, 5030400099 & RO01828.0502.09 Posting Date 23-Jan-22 Contract / PO No. 4508078716 Supplier Name CV. MECI ANGI Delivery Note ‘001/Ma/1/2022 Bill of Landing, HUU SITE [WH/IN/00037/2022] Requested by DAVIDR. Notes COMPLITE Na. [stock cope| DESCRIPTION LOCATOR, ary | UNTPRIce | Tora VALUE TEP BATU PECAH GREAKER Physical Locati 129.00] 85000000] ___109,650000.00 FTHERTOOSS lons/WH/StockOU. [TOOOR, recenevoy. __(asnna0 CHECKED / PICKED BY SIGN: | DATE. Notes: Original: Write 1 If this page isnot enough, please fillin the next page. 2. Please attach this goods / services receipt note when submit invoice. Form No. JI Raya Lakey Dusun Nangasia Desa Marada Kec Hu'u Kab Dompu 8427 LoftCV. MECI ANGI Jin, Lintas Lakey Dusun Lodo Desa Sawe Kee. Hu'u, Kab, Dompu -NTB, Indonesia Email : cvmeciangit6@gmail.com - Contact : 085338227548 CV, MECI ANGI JL. Lintas Lakey, Dusun Lodo, RT. 002/RW. 001 Desa Sawe, Kee. Hulu, Kab. Dompu, 84271 Nusa Tenggara Barat - Indonesia Contact : 0853-3822-7584 Delivery To: PT. SUMBAWA TIMUR MINING IL Raya Lakey, Kee. Hutu, Kab, Dompu-NTB, ‘Indonesia, 12430 DAP PT. SUMBAWA TIMUR MINING Account Payable Department o 010 [Batu PecalvBrcker 129 RET Delivery By, MUSMULIVADINyd eisouopul - 061Z1 eUeYEr ‘000"0S9" LE IT agOS 12 ‘Rey UeWUIPNS “PUBr IP 00°000°0S9°60L 1F}0L 40044 YI6zZ JOMO] SiNbag Sunuiyy anuity emequing Le oo'o00 050-0. oo'eoo ase Jezoz tose exme3 107 | ove or enrea our oud wun warogikiowonuy_| area eng ondusseq zequinn veg | wun | Anuen oun ALVA Sopnjoxo 9194 S09Ud woo ajen@elqefedsquncose uns ienyd : ew, O6L zl “euexer ‘QOS ‘10014 tngZ EMO] sINbas juewyedag aiqeAeg sjunoooy Buy snuwty emequins 16 £04 pasjonu “ojep ooj0nu! ou) Joye shea pL SNININ YNWLL WMYAINNS Ld Av ez 'eseuopul ‘eleg eveO5ue] ESN ndwog nn ‘s9y'epeseW BS9C'KoHe7 Aes IP Buy ‘eMeQUINS “Ld wisuy Arantieg eisavopuy 00000 ‘NaWoa “ABN SVINT TP ‘AO IDNW 13 869°2000 OL woo ejen@ueyedyed ynun yew-3 aLuOdNs-3a x84 faweinooig UON = GI 3221409 zeoz"bo'v0 :=1eq 9LZ82080S7 4ePiO eseysind Zi bs o6ed ‘suonpuco pue suis) SINS Ld e1y99Nans =} J9pi9 eseuping SUL peu on ou feus usuuted 10 SODIOAUI pue So1s0 iny uo vepi9 aseyaung uoene eseota Buruly anwiy emequing Id~000°01 “dy 1essjey, “kg pauBls Od Udi/dnl BueBewed ueeyesniad epedey edwojes epuied Yep UBBUEJe}9y YeINg UeBUEP lenses YepNs WLS Ld oy Alddns Ip ueye Bued uenjeq siuaf uey|seWoy- UdV/dNI Wed ep jese1eq seueq meq sequins emyeq Ueye\eAUaLL Sues nqipjedeg ueeyesnied epedey ueyninyip Bued (eweyesdey3 eBBUEY 1d) Ydl/dNI yIllWed UeeYesnied Yep se]UeBUad Jens UeYNINGIP UeBuap ingasie} Ydi/dM Welep Inqasia} JeUIPIOY / ISeyO| Ue Jese1eg Yelepe WLS 6 Aiddnsip Ueye BueA ueNFeqaq emyeq UeYAseLIAy\- Bunueg ueyeV9 euld Yeleq enpey Yolo ulue6UE} epue} Ip Yepns Bue ewHe) Yeleg eveoy e\NOg / IIsy UeIer Teng UaWNYog “RJON-3pieled INp{e4 -'000°O1 “dy leseveW IdeyBualp iisy eo10nu] ‘Og uawNyoq : UByldwejeyy desey eo1onuy /uey|Beued yuawnoop uedeyOueley yNUN (WLS Ld) Sulu nw eMequINg 1d UeUMINGey Ue>Lesepieq UeWHIBUEg ne}e/UEp UeETUIULEY YN ley O€ NM Weep }deq eoURUI4 epeday UEYLAQIP srueY UeYIBe JUSLUNYoq ~'000'0F ‘dy 1e1]2/V SeEIP BueuOMINg Jeqeled Yalo 1ueBUE\ePUEYIP sMueY IISy SOIONUI B Od - “BUIUINY INU, EMEGUINS Ld Ned UEINBUNWEg/LONOEIION LWA - + Sueveg UWUIBuag ISYNNISUl /LONONASU| Azan\jaq spoog, UBLINOq - “.esep neje/uep Bueseg UeyOsed yMJUN WNWUN UeN}UE}O¥ UEP JeIeKg - SEOILIES Jo/pue JeUO\eW\ Jo Alddng 40} LONIPUED »g WHA Je1BUeD, UAUINyog » WLS Ld #0M Jo adoog Uesidue| UatUunyop eped ynpUM JopYeNUOY UReLlaMJog dnyBury - uawinyop eped sidweye) Bujulyy snwl] emequing 14 ue: ued Jepuers isipuoy eped ynpuny [uy uEljaquied UeUeseg Buruiw anu 91282080Sp 4J98pi9 aseysing emequings Id Zz: ebeg