No.

PLO/09/F-017

PT. SAPTAINDRA SEJATI

PLANT DIRECTORATE
Graha Saptaindra Jln. TB. Simatupang Kav. 18 Cilandak Barat Jakarta Selatan Indonesia, 12430

CLAIM OF WARRANTY PROPOSAL

PROJECT : BORO SECTION : Plant Loader
CWP NO. : 11332 WO NO. : 2200509417
REPORT DATE : 28-May-22 CLAIM TO COMPANY : Cipta Hydro Power Abadi, PT

EQUIP. TYPE EGI CODE NUMBER MAJOR COMP.

EXCAVATOR PC2000-8 EX200-0049 Hydraulic System

PR NO. PO NO. PO AMOUNT

0 0 $0.00

FITMENT FAILURE
DATE : 02-Mar-22 DATE :24-May-22
HM / KM : 19,845.00 HM / KM :20,158.00
LIFE TIME : 313.00

Problem Description (Describe detail of failure, analyse the cause & operating condition)
HOSE DELIVERY CRACK, LIFE UNDER 4000 HM & 166 DAYS (Eks MO 2200448990)

Equipment Execution Status

Waiting Part/ Tools

Remarks Equipment Progress

24 MEI 2022 : CWP SENT

28 MEI 2022 : MSH WAITING PART

List of Failure Part (Main Part) : Reason if not Accepted :

Part Name Part Number

HOSE DELIVERY CV LH1 07084-01416HP

DECISION BY APPROVED BY PREPARED BY

ACCEPTED Decision Amount Warranty : PLANT SECTION HEAD PLANT ENGINEER
REJECTED Sign : Sign :
PRORATE
RECEIVED BY PLT , 28-May-22, 10:00:00 am
Sign : Sign :
PLT , 28-May-22, 10:00:05 am Name : DENNY
Date :
SUPERVISOR
Sign :
Name : Name : Name : ABDUL HARIS S.
PLT , 28-May-22, 10:00:03 am
Date : Date : Date :
Name: DENDY A.R
Date :
Revisi : 1