WORK ORDER FORM

Technical Operation Department

Customer Technical Support Installation
PT. Eka Mas Republik
Graha FIM, Jl. Teuku Cik Ditiro No. 37
Menteng, Jakarta Pusat 10310

Work Order Information Customer Information

No. WO 2621324 Customer ID C1777191

BAST Number Name Ammar Musthofa Firdaus
WO Date 20 Januari 2023 SA Date 20 Januari 2023
Appt. Date 21 Januari 2023 Service Status Pending
Service Aging Installation 0 PIC Ammar Musthofa Firdaus
Appt. Type Installation Address JAWA TENGAH PURWOKERTO (53182)
GRIYA TEGAL SARI INDAH RW 06
General Retail [RFS]
Project Name BOJONGSARI JLN. PEPAYA Number 8
[PWO.100.0101/GTSI-06.006/B04]
RW 6 / RT Kode Pos : 53182
Installation Type AERIAL
Class Type Customer Regular
Ticket Date 20 Januari 2023
Package/Plan Value30 Internet - ONT (4 Port) V2 -
Initiate Ticket Category
Billing Cycle Date
Value Account state 0
Mobile 082223868915
Phone
Email musthofaammar@gmail.com

Device Information
No Item ID Descriptions Serial Number Mac Address
1 ONTHW.001 HUAWEI OPTICAL NETWORK TERMINAL (ONT)
2

Main Material Information

Device
No Item ID Descriptions Serial Number Mac Address Remark Status
Model
1 ONTHW.001 HUAWEI OPTICAL NETWORK TERMINAL (ONT) ONT
2

Accessories Material Information

Material Material
No. Material Name Unit QTY No. Material Name Unit QTY
Code Code
1 200000083 Cable A/V 3m pcs 10 200000242 Terminal Box + adapter SC-APC pcs
2 11 Cable pathcord single mode 20 m (SC-
200000101 Cable duct/protector TC2 pcs 200000243 pcs
APC to SC-APC)
3 12 Cable pathcord single mode 50 m (SC-
200000102 Pipa PVC/Conduit 20 mm pcs 200000244 pcs
APC to SC-APC)
4 200000105 Clamp pipa conduit 20 mm pcs 13 200000245 Flexible 20mm (1m) meter
5 200000111 Sock pipa conduit 20 mm pcs 14 200000247 Adapter SC-APC to SC-APC pcs

6 200000117 Cable drop FO G657 dual core ( non mess ) meter 15 200000516 Splice-on Connector APC pcs
7 Cable drop FO G657 dual core With 16
200000118 meter 200000517 Splice-on Connector UPC pcs
Messenger
8 200000142 Pig Tail SC APC (2m) pcs 17 300000209 Fast Connector SC/APC pcs
9 Cable pathcord single mode 30 m (SC-APC 18
200000240 pcs 300000210 Fast Connector SC/UPC pcs
to SC-APC)

Free of charge: 150 meter note : Additional charge Rp 2500/ meter up to 100 meter
Remark to Contractor

Category Problem/Root Cause Analysis

Comments by Contractor

Technician Information Solution & Finishing

Area Purwokerto Installer Arrival Time
Contractor Konten Indomedia Pratama, PT Work Completed TIme
Installer Name Aditiya Arisandi Appt. Status/Work Order Successful
Installer Contact No. 085865480845 St Unsuccessful
Slot Time 9am to 11am

Dengan menandatangani lembar kerja ini saya menyetujui semua hasil kerja dan perbaikan yang sudah dilakukan dengan hasil baik
Purwokerto, ...................................................

Cust. Technical Support Signature Customer Signature & Name