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               ALL      E 3              

e
T       e         12 Me  2
Pemeriksaan/lnspeksi Kendaraan Berinotor
Vehicle Inspection
Date /  Tanggal B
Police No /  No Polisi                            .

Odometer  /  Kilometer
Vehicle Type /  Jenis Kendaraan          .
G
4 Prost  Plate /  Plai No. Depan
Rear Plai / Plat lNo. Belakang
5 Its om Mk / Babu OR pick—Up)
9 front Ftaser ).ight / Lamgu Tanda Belok Depa»
Rear Fla     ”L gh  /                            Belok Beta     ng     ”

                                                                                      Not Available / Ticlak DijiimpaJ


emeriksaan/lnspeksi Kendaraan Berinotor
Vehicle Inspection
IS  Ueseoiher 20t4 B 9519 DBA
Mi tenbishI/Donb1e Cab in
N
21 Jack Handle /  Tank Dongrak 22 Tire Wiech /  K-i     Rodo
24 Triangle / Sag T ga Pengao+an 25 Cuter Mirror / Para Spion
26 Engine oil /  OIi Mesin

ot Available / Ticlak DijiimpaJ

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