PURCHASE REQUEST PR. No. : P2100405 - 0011003016 Date : 30-Apr-2021 Project Name : Card OLT for maintenance Bali Area Department : Engineering & Operation Department DESCRIPTION OF ITEMS No Description Budget Line Qtty Unit Unit Price Rate TOTAL PRICE Expected Date 1 ZTE Big - Service Card CEQPELC301 2 EA IDR 55,387,680 1 110,775,360 30-Apr-2021 2 ZTE Big - Controller Card CEQPELC301 1 EA IDR 23,129,385 1 23,129,385 30-Apr-2021 3 ZTE Big - SFP GPON CEQPELC301 10 EA IDR 1,095,765 1 10,957,650 30-Apr-2021 4 ZTE - Rectifier CEQPELC301 1 EA IDR 27,234,480 1 27,234,480 30-Apr-2021 Grand Total 172,096,875 JUSTIFICATION 1. Purpose Pengadaan card OLT untuk backup area Bali. Backup tersebut diperlukan karena jika ada problem di OLT bisa segera perbaiki. * please describe : - reasons & background - highlight the important of this capex 2. Life Expectancy 5 Year * please describe for each item, if not in the same category 3. Impact analysis OLT tidak bisa dilakukan perbaikan jika mengalami kerusakan. Service FTTH akan off * please describe what is the impact if capex is not purchased 4. Recommendation . * highlight efficiency can we got if capex is purchased COMPARISON OF SUPPLIERS No Supplier Name Lead-Time Total Price Term of Payment Remarks BUDGET ALLOCATION 1. Budget Line No. : 2. Total Budget Value : Remarks : Budget Line & Description Original Budget Value Remaining YTD As of date Balance of Budget LN09109 - 0000040000 - CEQPELC301 3. Notes : 4. Approve : ( )Yes ( )No REMARKS & NOTES FROM FINANCE & FUNCTIONAL RELATED (if applicable) (ex. : MIS & IT, HR & GA, etc) Requested by Authorized by Approved by Agus Afandi Didi Harijanto Victor Indajang Date : Date : Date : Management Approved by Cost Control Deputy CFO Andry Widya Tanus Susanto Date Date