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| No. Kode Sirkit | : ............................................... | No. Kontak | : ............................................... | ||||||||
| Lokasi | : ................................................ | Link ke | : ................................................ | ||||||||
| Pada hari ini ......., tanggal ...... bulan ............ tahun ............ telah dilakukan Uji Terima antara pihak : | |||||||||||
| 1 | PEMAKAI | : ........................................................ | |||||||||
| Nama | : ........................................................ | ||||||||||
| Jabatan / No.HP | : ................ / ...................................... | ||||||||||
| Alamat | : ........................................................ | ||||||||||
| 2 | PENYEDIA JASA | : PT TELKOM INDONESIA (PERSERO) TBK | |||||||||
| Nama | : ........................................................ | ||||||||||
| Jabatan / No.HP | : ................ / ...................................... | ||||||||||
| Alamat | : Telkom Landmark Tower Lt. 21, Jalan Gatot Subroto Jakarta | ||||||||||
| Telah melaksanakan uji terima perangkat dalam rangka penyediaan jasa Jarkom sesuai No. Kontrak diatas. | |||||||||||
| A | Layanan | ||||||||||
| Jenis | : ........................................................ | ||||||||||
| Tech | : ........................................................ | ||||||||||
| Hasil | : ........................................................ | ||||||||||
| B | Total Rate | ||||||||||
| ........................Kbps / Mhz........................ | |||||||||||
| Tx / Rx Site | Data rate (Kbps) | Satelite / Transponder | Frekuensi | Antena : ____ meter | ||
|---|---|---|---|---|---|---|
| Start | Center | Stop | Operating Band : ______ band | |||
| Longitude : ____________ E/W* | ||||||
| Latitude : ____________ E/W* | ||||||
| C | Kesimpulan | ||||||||||
| Layanan dinyatakan siap beroperasi sejak tanggal : ................................. dan diintegrasi pada tanggal : ................................ dengan hasil baik. | |||||||||||
| PIC Pelanggan di lokasi adalah ...................................................... dengan No. HP .................................................. | |||||||||||
| Keterangan : STATUS LAHAN ........................................................ (Sewa/....................). PIC LAHAN.................................................. TELP................................................. | |||||||||||
| D | Status Berlangganan : ........................................................ Berbayar/Tidak Berbayar/Demo* | ||||||||||
| .............., ......................... ..................... | |||||||||||
| PT TELKOM INDONESIA (PERSERO) TBK | PEMAKAI | ||||||||||
| (.....................) | (.....................) | ||||||||||