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PT INTIMANDIRI Date: 31-Dec-20

Reception Site / Warehouse: Gudang Dipatiukur

GOODS RECEIVED NOTE (GRN) No.: GRN-2619

DO No.: D0-2619 Transport Co.: Hino-GP Truck No.: B-234-DY

Origin: Jakarta Driver: Mr. Dino Trailer No.: TU5SWR

PO Number: PO-327
Condition Of Unit QTY Received Upon Arrival and Discharge

Missing / Short- Broken, Torn or Damaged Units (wet, Empty and Light Total Damaged &
PL# Unit QTY Landed Units Leaking Containers crushed, etc.) Units Missing
Description According to DO
Good Condition

(A) (B) (C) (D) (A + B + C + D)

Pipa 1" B03 D0-2619 30 - - - - -

TOTALS: 30 - - - - 30

We the undersigned declare that we witnessed the unloading of the truck identified above, and we concur that the products and commodities listed were received in the condition as noted:

NOTE: By signing, individuals verify the authenticity of this document; it IS NOT an admission of responsibility for loss or damage.

Signature Warehouse Mgr: Mr. Leo Driver: Mr. Dino Date: 31 Dec 2020

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