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FORMULIR PERHITUNGAN TINGKAT KOMPONEN DALAM NEGERI DOMESTIC CONTENT CALCULATION FORM FORMULIR No. : SC-02 Deskripsi/Description Nama Peserta/Bidder Name : Total Nilai Penawaran/ Total Quoted Price: Butir/Item % Komponen Dalam Negeri (KDN)/ Domestic Content (DC) Komponen Dalam Negeri Penawaran/ Quoted Domestic Content Nilai per Item /Item Value % Nilai/Value % a b c d = a x c e A. BARANG/GOODS I. MATERIAL TERPAKAI Used Materials II. PERALATAN Equipment Sub Total (A) B. JASA/SERVICES III. PERSONIL/KONSULTAN Personnel/Consultant IV. ALAT KERJA/PERALATAN Tools/Equipment V. KONSTRUKSI/FABRIKASI Construction/Fabricati on VI. JASA UMUM DLL. Other Services Sub Total (B) C. JUMLAH (T O T A L)= Sub Jumlah A+ B b : Nilai per Item/Jumlah Nilai Penawaran x 100% e : Nilai KDN Penawaran/Jumlah Nilai Penawaran x 100% Catatan/Note: Personil/Konsultan : Rekayasa, survey perencanaan, pengawasan, manajemen, tenaga kerja, dll. Personnel/Consultant Engineering, research design, supervision, management, personnel etc. Alat Kerja/Peralatan : Sewa rig, sewa kendaraan, sewa kapal, sewa pompa, dll. Tools/Equipment Rental of rig, vehicle, barge, pump, etc. Konstruksi/Fabrikasi : Konstruksi sipil, mesin, listrik, dll. Construction/Fabrication Civil, mechanical, electrical construction, etc. Jasa Umum dll. : Pengurusan, asuransi, sewa rumah, dll.

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FORMULIR PERHITUNGAN TINGKAT KOMPONEN DALAM NEGERI DOMESTIC CONTENT CALCULATION FORM

FORMULIR No. : SC-02

Deskripsi/Description

Nama Peserta/Bidder Name :

Total Nilai Penawaran/ Total Quoted Price:

Butir/Item% Komponen Dalam

Negeri (KDN)/Domestic Content

(DC)

Komponen Dalam Negeri Penawaran/Quoted Domestic

ContentNilai per Item/Item Value %

Nilai/Value %

a b c d = a x c eA. BARANG/GOODS

I. MATERIAL TERPAKAIUsed Materials

II. PERALATANEquipment

Sub Total (A)

B. JASA/SERVICESIII. PERSONIL/

KONSULTAN Personnel/Consultant

IV. ALAT KERJA/PERALATAN

Tools/EquipmentV. KONSTRUKSI/

FABRIKASI Construction/Fabrication

VI. JASA UMUM DLL. Other Services

Sub Total (B)

C. JUMLAH (T O T A L)=

Sub Jumlah A+ B

b : Nilai per Item/Jumlah Nilai Penawaran x 100%e : Nilai KDN Penawaran/Jumlah Nilai Penawaran x 100%

Catatan/Note:Personil/Konsultan : Rekayasa, survey perencanaan, pengawasan, manajemen, tenaga kerja, dll.Personnel/Consultant Engineering, research design, supervision, management, personnel etc.Alat Kerja/Peralatan : Sewa rig, sewa kendaraan, sewa kapal, sewa pompa, dll.Tools/Equipment Rental of rig, vehicle, barge, pump, etc.Konstruksi/Fabrikasi : Konstruksi sipil, mesin, listrik, dll.Construction/Fabrication Civil, mechanical, electrical construction, etc.Jasa Umum dll. : Pengurusan, asuransi, sewa rumah, dll.Other Services etc. Management handling, insurance, house rent, etc.Material Terpakai : Pipa, Semen, Chemical, dll.Material Used Pipe, Cement, Chemical, etc Peralatan : Pompa Kompresor, Generator dllEquipment Pump, Compressor, Generator, etc

Tanda Tangan : Signature