Form - CCOW

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CERTIFICATE

COMPLETION OF
WORK
Pergudangan Bandara Mas, blok T, No 6
Selapajang Jaya, Neglasari, Tangerang 15127, Banten
Indonesia - 15127 PAGES :
Tel : +62 21 5572 8533, Email : ama@aero-mitra.com

1. CUSTOMER 5. MANUFACTURE 9. CCOW NO

2. ADDRESS 6. MANUFACTURING YEAR 10. DATE

3. EQUIPMENT NAME 7. LAST MAINTENANCE RECORD 11. CUSTOMER WO REFF :

4. MODEL / PART NUMBER 8. MAINTENANCE BY 12. INSPECTION REPORT REFF:

THIS IS TO CERTIFY THAT :

INSPECTION OVERHAUL / REFURBISHMENT OTHERS


PLEASE SPECIFY…...
SERVICE & REPAIR LOAD TEST

HAS BEEN PERFORMED TO THE FULL SATISFACTION OF CUSTOMER

DESCRIPTIONS

I. SPECIAL NOTES : II. TECHNICIANS & INSPECTOR NAME

CUSTOMER ACCEPTANCE DATE OF ACCEPTANCE

NAME

SIGNATURE DESIGNATION

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