a (Mf PERTAMINA fr PHE NSB ‘Service Order PO NUMBER / DATE: PAYMENT ‘SHIPPING TO: To: BANK MANDIRI DELIVERY DAI TE: PO Service 3900001382 / 20.09.2016 | NSB Field VENDOR: APO Point A, Nibong JLJEND GATOT SUBROTO KAV 36-38 GF. COTNDO JAY oc rama REFERENCE / DATE: Lhoksukon, Aceh Utara 24381 JAKARTA THOKSEUMAWE, 2435 6500001917/20.09.2016 JAKARTA PLAZA MANDIRI Nangaros Aceh Gruss Indonesia A aerasce ‘VENDOR NUMBER: Account No. : 1580001143866 182825 ‘Account Holder_: CV COTINDO JAYA ‘Vendor NPWP: IMPORTANT: 03.105.151.9-102.000 11, General Terms and Condition see Attachment Terms of delivery : Currency: IDR Payment Method : Bank Transfer Terms of payment : Within 80 days 0,000 % cash discount item] Material Noy] Serv | Quantity | Unit | Description Price per unit | Value Delivery Service No Group| - : Date 10 899 1] AU | 30" Bellhole inspection on SLS Row Pipeline 14,200.00 14,200,000] 24.10.2016 1. To remave wrapping, coating and cleaning by power tool for inspection. Re-coating and re-wrapping after NOT completion and Holiday test of pipe at KM-28 and 30 SLS Pipeline. 2. Injection Compound Seal for 30° pipe clamp of SLS pipeline at KM-29 and 30. ‘THE ITEM COVERS THE FOLLOWING SERVICES: 10.1 2 EA | -To remove wrapping, coating and cleaning 6.000.000 12,000.00 10.2 2 EA _| - Installation Compound Seal for 30" pipe 1.100.000 2.200.000 Remarks : 1, Ref PR No 300001313 2. Req quotation CV Cotindo Jaya Tanggal 14-09-2016 Page 1 of 3a (7 PERTAMINA fr PHE NSB Service Order PO Service PO NUMBER / DATE: 3900001382 / 20.09.2016 Currency: IDR 3. Terms and Conditions terlampir Page 20f 3 Ata (7 PERTAMINA PHE NSB Service Order PO NUMBER / DATE: Currency: IDR PO Service 3900001382 / 20.09.2016 Total Price in IDR: 14.200.000 Total net value excl. tax IDR: 14.200.000 VAT in IDR: ° Total net value inel. tax IDR: 14.200.000 FOURTEEN MILLION TWO HUNDRED THOUSAND RUPIAH We confirm our acceptance of this PO on the terms and conditions herein stated. 4 GENERAL MANAGER Signature: Name: a Date: Approved by: Page 3 of 3a B® PERTAMINA PHE NSB ‘Service Order PO NUMBER / DATE: Currency: IDR ce PO Service 3900001382 / 20.09.2016 Total Price in IDR: 14.200.000 Total net value excl. tax IDR: 14,200,000 VAT in IDR: o Total net value incl. tax IDR: 14,200,000 FOURTEEN MILLION TWO HUNDRED THOUSAND RUPIAH We confirm our acceptance of this PO on the terms and conditions herein stated. Signature: Name: Date: Approved by: ENERAL MANAGER \ Pose 803 any