Berita Acara of MOS Completion

PROJECT : Indonesia BAKTI 4G BTS Project

In this day,Tuesday date 03th (Tri) month November year 2022 (TwoThousand and
Twenty-Two):

1. Name : Xie Kunlun

Position : Regional Project Manager
Act as and On Behalf of PT. Fiberhome Technologies Indonesia, Herein after
referred as FIBERHOME; and

2. Name : Alfi Irawan

3. Position : Director
Act as and On Behalf of PT. Tri Adhigana Herein after referred as
Contractor.

Based on :
1) Material List :
PT. FiberHome Technologies Indonesia stated that based on above :

PT. Tri Adhigana has completed above MOS and confirmed by FIBERHOME.

This Agreement is made in 2 (two) sets of original, with company stamped therefore
shall be executed by duly representative of the Parties.

Jakarta, 3 November 2022

PT. FiberHome Technologies Indonesia PT. Tri Adhigana

[……………….……....] [ Alfi Irawan ]

Superviser Director

[..………………………..]
Regional Project Manager
Material list:
SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3

2 Stone 30m3 30m3
NTT0048 3 Sand 35m3 35m3
4 Cement 260 Bag @50Kg 260 Bag @50Kg
5 Rebar 210 Ujung (16.10.12.8 210 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3

2 Stone 15m3 15m3
NTT0079 3 Sand 20m3 20m3
4 Cement 105 Bag @50Kg 105 Bag @50Kg
5 Rebar
60 Ujung (16.10.12.8)
SITE ID No. Material Description APD Qty Actual Qty
1 Formwork 1,5m3 1,5m3
2 Stone 24m3 24m3
NTT0096 3 Sand 33m3 33m3
4 Cement 220 bag @50Kg 220 bag @50Kg
5 Rebar 154 Ujung (16.10.12.8) 154 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3
2 Stone 30m3 30m3
NTT00111 3 Sand 35m3 35m3
4 Cement 250 Bag @50Kg 250 Bag @50Kg
5 Rebar 136 Ujung (16.10.12.8) 136 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3
2 Stone 39m3 39m3
NTT00127 3 Sand 42m3 42m3
4 Cement 320 Bag @50Kg 320 Bag @50Kg
5 Rebar 245 Ujung (16.10.12.8) 245 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3
2 Stone 30m3 30m3
NTT00475 3 Sand 40m3 40m3
4 Cement 250 bag @50Kg 250 bag @50Kg
5 Rebar 180 Ujung (16.10.12.8) 180 Ujung (16.10.12.8)
SITE ID No. Material Description APD Qty Actual Qty
 1 Formwork 1,5m3 1,5m3
2 Stone 30m3 30m3
NTT00476 3 Sand 35m3 35m3
4 Cement 260 Bag @50Kg 260 Bag @50Kg
5 Rebar 210 Ujung (16.10.12.8 210 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3

2 Stone 15m3 15m3
NTT00479 3 Sand 20m3 20m3
4 Cement 105 Bag @50Kg 105 Bag @50Kg
5 Rebar
60 Ujung (16.10.12.8)
SITE ID No. Material Description APD Qty Actual Qty
1 Formwork 1,5m3 1,5m3
2 Stone 24m3 24m3
TT00480 3 Sand 33m3 33m3
4 Cement 220 bag @50Kg 220 bag @50Kg
5 Rebar 154 Ujung (16.10.12.8) 154 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3
2 Stone 30m3 30m3
NTT00586 3 Sand 35m3 35m3
4 Cement 250 Bag @50Kg 250 Bag @50Kg
5 Rebar 136 Ujung (16.10.12.8) 136 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3
2 Stone 39m3 39m3
NTT00623 3 Sand 42m3 42m3
4 Cement 320 Bag @50Kg 320 Bag @50Kg
5 Rebar 245 Ujung (16.10.12.8) 245 Ujung (16.10.12.8)

SITE ID No. Material Description APD Qty Actual Qty

1 Formwork 1,5m3 1,5m3
2 Stone 30m3 30m3
NTT00683 3 Sand 40m3 40m3
4 Cement 250 bag @50Kg 250 bag @50Kg
5 Rebar 180 Ujung (16.10.12.8) 180 Ujung (16.10.12.8)
 Photos For Material On
Site
Site ID：NTT0048

1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site
Site ID：NTT0079
1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site
Site ID：NTT0096
1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site
Site ID：NTT00111
1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site
Site ID：NTT00127
1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site
Site ID：NTT00475
1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Photos For Material On
Site
Site
Site ID：NTT00476
1. Formwork

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site ID：NTT00479
1. Formwork Site

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
Site
Site ID：NTT00586
1. Formwork Site ID：NTT00480

2. Stone

3. Sand

4. Cement

5. Rebar
 Photos For Material On
1. Formwork
Site
Site ID：NTT00623

2. Stone

3. Sand

4. Cement

5. Rebar
1. Formwork Photos For Material On
Site
Site ID：NTT00683

2. Stone

3. Sand

4. Cement

5. Rebar

1. Formwork
2. Stone

3. Sand

4. Cement

5. Rebar