*CONTRACTOR LOGO* CONTRACTOR MANPOWER REGISTER

No Name Position Company

1 Ilham Gobel Jr. Purchaser PT. Decorient Partaya Indonesia

2 Denny Ardyanto Setyawan Driver PT. Decorient Partaya Indonesia
3 Lucky Riza Hendrawan Operator PT. Pakubumi Semesta
4 Joko Suparman Helper PT. Pakubumi Semesta
5 Ujang Robi Helper PT. Pakubumi Semesta
6 Muhamad Rizky Fajar Site Manager PT. Pakubumi Semesta
7 Afif Uddin Al Asyhari Supervisor PT. Pakubumi Semesta
Moh.Amrulloh Sani Adam Adm PT. Pakubumi Semesta
8 Nicolas Kalangie Operator PT. Pakubumi Semesta
9 Samsul Arifin Rigger PT. Pakubumi Semesta
10 Ngajis Operator PT. Pakubumi Semesta
11 Saiful Rohman Helper PT. Pakubumi Semesta
12 Emod Muhammad Operator PT. Pakubumi Semesta
13 Dwi Suprayitno Rigger PT. Pakubumi Semesta
14 Wawan Hermawan Rigger PT. Pakubumi Semesta
15 Arfian Prajuliansah HSE Advisor PT. Decorient Partaya Indonesia
16 Antonius Ariyanto Operator PT. Decorient Partaya Indonesia
17 Mukhlis Surveyor PT. Decorient Partaya Indonesia
18 Mohammad Suwandi Electrician PT. Decorient Partaya Indonesia
ID Employe Email Phone Number Hire Date Induction Date

010722 jhuels.hole@gmail.com 082131127275 8/1/2022 7/28/2022

020722 denny.cypenk@gmail.com 082159099753 7/27/2022 7/28/2022
5170 0815855580003 7/28/2022
c1698 7/28/2022
c1210 085875430017 7/28/2022
5516 rizkyfajar98.rf@gmail.com 0895410233022 7/4/2022 7/28/2022
C1496 penyox.black@gmail.com 082265069107 11/12/2011 7/28/2022
C1820 muhammad.amrulloh7824@gmail.com 081295265603 23/7/2022 7/28/2022
7/28/2022
7/28/2022
1042 081911738461 7/28/2022
c1453 089687961086 7/28/2022
7/28/2022
c1190 087700346466 7/28/2022
7/28/2022
arfianprajuliansyah@gmail.com 082139540888 8/1/2022 7/28/2022
7/28/2022
mukhlismukhlis0x1@gmail.com 085268190986 8/1/2022 7/28/2022
kusumasuwandi8@gmail.com 082137176463 8/1/2022 7/28/2022
 MCU
Date Type of MCU MCU Status Remarks
7/26/2022 MCU
7/26/2022 MCU
 Place of Birth Date of Birth Identity number BPJS Ketenagakerjaan BPJS Kesehatan

Sumenep 20/12/1972 3578152012720002 922072002947264 on progress

Tuban 07/12/1980 3523160712800002 922072002947264 0002078809209
Boyolali 26/06/1989 3309182606890004
Kab. Semarang 21/10/1977 3322022110770002
Karawang 07/08/2000 3215240708000001
Yogyakarta 22/07/1998 3471082207980002
Kab. Semarang 06/04/1991 3322020604910002
Tegal 24/06/1994 3171042406940000
Bitung 04/05/1961 3172020405620001
Bojonegoro 11/04/2002 3522161004020001

Bojonegoro 16/06/2000 35221616060000002

Lamongan 7/5/1986 3524220507860002 12013974782 on progress

Lamongan 18/10/1979 3524050910790002
Tarung - Tarung 3/28/1991 1308172803910001 on progress
Batang 3/28/1981 3325112803810001 on progress 0001264804435
Other Health Insurance
Address
(if any) Village
Tanjung Sadari Kolombo No. 12 RT 005 RW 007 Perak Barat
Gg. Seroja No. 92 RT 003 RW 001 Doromukti
Trumun RT 001 RW 003 Wonosegoro
Patemon RT 003 RW 001 Patemon
Dusun Peundeuy RT 003 RW 009 Cicinde Utara
Krapyak Kulon RT 004 RW 000 Panggungharjo
Kadipurwo RT 001 RW 006 Bener
Jl.Senayan No.49 Rawa Barat
Kamp. Bahari Gg.II/198 RT 001 RW 006 Tanjung Priok
Vringan RT 013 RW 001 Ngraho
Nobo Tengah Rt.1/ Rw. 7 Noborejo
bringan RT.13/ RW.1 Ngraho

Nobo Tengah Rt.1/ Rw. 8 Noborejo

Mendalan Gg. Belanak No.02 RT 002 RW 002 Banjarmendalan

Jl. Mutiara XIV / 12 PPS RT 010 RW 018 Suci
Bukoreh RT 000 RW 000 Padang Gelugur
J Pemuda Gg. Guntur Dk. Kadilangu 1/7 Kauman
 Place of origin
Subdistrict City Province Island Nationality
Krembangan Surabaya East Java Java Indonesia
Tuban Tuban East Java Java Indonesia
Wonosegoro Boyolali Central Java Java Indonesia
Tengaran Semarang Central Java Java Indonesia
Banyusari Karawang West Java Java Indonesia
Sewon Bantul DI Yogyakarta Java Indonesia
Tengaran Semarang Central Java Java Indonesia
Kebayoran Baru Jakarta Selatan DKI Jakarta Java Indonesia
Tanjung Priok Jakarta Utara DKI Jakarta Java Indonesia
Gayam Bojonegoro East Java Java Indonesia
Argomulyo Semarang Central Java Java Indonesia
Gayam Bojonegoro East Java Java Indonesia
Indonesia
Argomulyo Semarang Central Java Java Indonesia
Indonesia
Lamongan Lamongan East Java Java Indonesia
Manyar Gresik East Java Java Indonesia
Padang Gelugur Pasaman West Sumatera Sumatera Indonesia
Batang Batang Central Java Java Indonesia
 Emergency Contact Blood Vaccination (Date)
Classification Sex
Phone number Relationship Type 1st Dosis 2nd Dosis
Gresik regency Male 082142560198 Father AB 10/26/2021 11/28/2021
East Java Male 082232299579 Father O 9/28/2021 10/28/2021
Java Male 082170909477 work partner 11/13/2021
Java Male 082170909477 work partner 11/16/2021
Java Male 082170909477 work partner 9/21/2021
Java Male 082170909477 work partner O 10/4/2021 11/1/2021
Java Male 082170909477 work partner O 8/23/2021 9/24/2021
Java Male 082170909477 work partner AB 23/07/2021 20/08/2021
Java Male 082170909477 work partner O 9/20/2021 10/11/2021
East Java Male 082170909477 work partner 8/23/2021 9/20/2021
Java Male 082170909477 work partner B
Java Male 082170909477 work partner
Male 082170909477 work partner
Java Male 082170909477 work partner
Male 082170909477 work partner
East Java Male 082139540888 Family 9/13/2021 10/13/2021
Bungah Subdistrict Male
Outside Java Male 082213056476 Family 9/29/2021 1/9/2022
Java Male B 8/30/2021 9/30/2021

Notes:
Java = Exclude East Java Hire
East Java = Exclude Gresik and Surabaya
Gresik Regency = Exclude Manyar and Bungah District
Bungah Subdistrict = Included all the villages in Bungah Subdistrict
Manyar Subdistrict = All villages Exclude Manyarejo, Manyarsidomukti, Manyarsidorukun
Remarks

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