F O R M B IA Y A P E N G IR IM A N B A R A N G

N A M A P E N N G E M U D I : T A N G G A L K IR IM :

N A M A K E R N E T : T U J U A N K IR IM :

N O P O L : :

K M P E N G IS IA N

S E B E L U M N Y A : Q T Y B A R A N G :

K M P E N G IS IA N : N O .S J :

J E N IS B IA Y A N IL A I (R p ) K E T E R A N G A N

B B M @ R p .

B O N G K A R M U A T

T O L

P A R K IR

D IN A S L U A R K O T A

R E T U R

L A IN -L A IN

J U M L A H

D IS E T U J U I, R A S IO K M /B B M D IB U A T O L E H ,

( ) ( )

C O N T R O L S H E E T

P E N G E C E K K A N K E N D A R A A N S E B E L U M P E N G IR IM A N

N o m o r K e n d a ra a n : T a n g g a l :

D r iv e r :

H A S IL P E M E R IK S A A N
N o . P E M E R IK S A A N K E T E R A N G A N
B a ik /A d a K u r a n g /T id a k

1 O li M e s in P e r h a tik a n p o s is i g a r is ( = ) B a ik , ( - ) K u r a n g

2 A ir R a d ia to r C e k b a g ia n R a d ia to r d a n K e m p is

3 M in y a k R e m C e k K o n d is i, ja n g a n s a m p a i p o s is i tu r u n

4 L a m p u -L a m p u C e k S e m u a In d ik a to r

K o n d is i B a n (te rm a s u k
5 C e k A n g in d a n K e m b a n g n y a
S e re p )

6 B a u d R o d a P a s tik a n k o n d is i k e k e n c a n g a n B a u d

7 A ir A c c u C e k A ir d a n K o n e k t o r ( K a la u k o to r , b e r s ih k a n )

8 R e m T a n g a n P a s tik a n b e r ja la n b a ik

9 W ip e r P a s tik a n b e r ja la n b a ik

1 0 S u ra t-s u ra t K e n d a ra a n C e k K e le n g k a p a n d a n M a s a B e r la k u n y a

1 1 D o n g k ra k C e k a d a tid a k n y a d a n b e r fu n g s i tid a k n y a

1 2 K u n c i R o d a

1 3 T u tu p T a n g k i P a s tik a n d a la m k o n d is i R a p a t

1 4 P 3 K

1 5 S e g itig a P e n g a m a n

1 6 G e m b o k P e n g a m a n

D ip e r ik s a o le h , D iv e r ifik a s i o le h ,

(_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ) (_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ )