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OWNER CONSULTAN SUPER

Construction of Housing in Aceh Bes

Contract No: AJ/HCONLocation : Desa Bak Paoh - Lamno - Na

FORMULIR INSPEKSI PENYELESAIAN RUM

BENEFICIARY H!"E C#PLE$I

ALI BA"YAH

No

a

%

c

&

ECF

Contractor Contractor Agree&

ECF

Distri%ution : ECF ' "P# ' Fiel& ((ice ' File

*+

Penerima BantuanBeneficiary

Nomor Plot : C#-,./ .B 01/23+um!er

A: Inspesi !ersa"a peneri"a !antuanInspection with Beneficiary

B: Jad#a$ %er!aian &er'aRemedial Work

$anggal Ins6eksi#ns$ection %ate

)eti$ &erusaanDetails of Defects :

%er!aian &er'a yg di$asanaanRemedial Work Required

"a8a 6enerima %antuan #the !eneficiary

*raianRemarks

menerima 6emilikan rumahacce$t $ossession of the house

setu7u utk men8e&iakan 7alan %agi kontraktor untuk

mem6er%aiki &a(tar kerusakan agreeto $ro&i'e access to the contractor to reme'y the liste' 'efects

telah mem%aca &an mengerti Prose&ur untuk mela6orkan

4erusakan %angunan ha&e rea' an'un'erstoo' the Proce'ure for re$orting construction 'efects ,-ormQA/1.0

sa8a mengerti %ah9a &iharuskan mem%eri la6oran

kerusakan se%elum *+ #un'erstan' # must re$ort any 'efects !efore 0

Ditan&a tangani oleh :Signe'

Nama :ame 3

Namaame

$an&a tanganSigne' $an&a tanga

"ign :

Contractor Agree'

Na"a:Name :

$an&a tangaSign 3

11 Month from #ns ection

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Co"pati!i$ity +eport for Handoer chec$ $ist 1-.-.$s

+un on 1/0/-002 13:-7

4inor $oss of fide$ity5 of occurrences

$he (ollo9ing (eatures in this 9ork%ook are not su66orte& %8 earlier