Address: PT.

Gresik Power Indonesia Plant Code 5165 - GPI

Jl. Raya Roomo, Manyar Requester Guntari Arifin

Material/Service Requisition Form

*MR No. : Ordering request to Antonius M. P.
Revision No.: 0
Date: 09/11/22
Requester ID: TBA
0.00040464
Annual / One-off One-Off Forecast N/A

NO. WO/IO No. Description Specification Qty UoM Estimated Budget (IDR) Delivery Location Expected Delivery Date SC Creator

Fabricate IC Stiffner as per

1 80141669 See attachment 10 set TBA Gresik 15-Dec-22 Heru Setiono
drawing

Purpose of Purchase: To replace IC stiffner of ASU compressor

Urgency Urgent Normal Low

Attachment ( SOW & BOQ/Catalog/Data Sheet/Photographs/Drawings ) attach file link or file copy

SOW BoQ Data Sheet Catalog Drawings Photographs

QUOTATIONS/PROPOSALS RECEIVED

Approved Supplier/
Supplier/ Service Provider Date Price Offered Remarks
Service Provider YES/NO
Tjokro bersaudara Yes TBA TBA

Wahana Niaga Yes TBA TBA

Boma Bisma Indah

Recommended /SupplierService Provider

Reason(s) of recommendation

Proposed By: Supriyadi signature

Guntari Arifin signature

Mokh. Agus Salim signature

A