SERVICE RECEIPT SHEET ( S R S )

Service Receipt Sheet No. : 17 / SAM / SRS / VIII / 2022

Date of issue document : 12 Agustus 2022
Vendor / Contractor Name : PT. SAMIYASA ADIDAYA MULIA INDONESIA
Purchase Order (PO) No. : 7210056202
Jobs Description (short) : ApexCrete Flat Floor Gudang Kerdus
Location / Plant : Cirebon
PO Value (in IDR) : 272.855.500 IDR
Work progress due date : 28/07/2022 until 07/08/2022
Jobs value will be charged : 66,442 % 181.290.274 IDR
Left to complete job : 33,558 % 91.565.226 IDR
is the Job final delivery ? : - (Y/N)
Service Entry Sheet (SES) No. :
Acceptance No. :
External No. : 17 / SAM / VIII / 2022

Filled by user / client (from Holcim)

Scoring Bellow Expected Meet Expected Above Expected
Corporate Social Responsibility (CSR)
Comply with CSR general regulation and policy (internal HIL / external/government)
Environtment
Comply with applicable requirements in national & provincial in Indonesia &
local environmental acts, regulations, rules, and guidelines
House keeping post job execution
Contractor Sales & Support
Warranty
Expertise availability
Compensation (ex penalty for late delivery, etc)
Response time
Technical assistance and handling complain
Labor availability and skill
Equipment availability and quality
Work Quality
Adherence to specification
Conformance to plan & execution
Meet specified service requirement
OH & S
Consisten use of PPE's
Demonstrate compliance with the implementation of occupational healt and safety
Security
Compliance with company security rule & regulation
Note :
Range of scoring 100 - 90 Above expected
- just leave the scoring for item that there is no relevance to
60 - 89 Meet expected the work-related
General Comment 0 - 59 Bellow expected - entry T-Code in SAP => zmm_0096

Submitted by Vendor Reviewed & Approved by Holcim *)

Director / Manager TL/SI SI/MGR

*) Value ~ 50 Mio, approver => TL & SI

(………Kasmini…………..) (……………………………...…….) (…………………………………..) Value > 50 Mio, approver => SI & MGR

Document Flow Important !

Contractor/Vendor
1. Submit doc "Service Receipt
Sheet" (SRS) for :
- job progress claim or
- final completion claim
2. Prepare 2 set original SRS docs
Required Docs for Invoicing
Holcim - User Dept Contractor/Vendor Holcim - P2P Dept
1. Invoice documents (original)
1. Review SRS docs 1. Sent invoice to P2P included 1. Received and verify the 2. Purchase Order (copy)
2. Sign for approval the original SRS invoice docs 3. Service Receipt Sheet (original)
3. Entry in SAP 2. Sent another set SRS to 2. L I V Process 4. Faktur pajak / tax invoice (original)
- SES then fill to SRS Docs Procurement 3. Payment refer to PO 5. Invoicing max within 3 month since
- Scoring contractor perfomance term and condition jobs completion done, else invoice