Confidential Property

ofEMRPassive Network
Planning

TECHNICAL SITE SURVEY REPORT

Complex/Cluster/Building
Perumahan Kartoharjo Indah
Name
Site Address

Hub Plan Name MADIUN

OLT / Sub Hub Plan Name MADIUN

Survey Date 16 JANUARY 2023

Survey Company SAPUTRA GLOBAL NUSANTARA

PT. EKA MAS REPUBLIK

MyRepublic Plaza 1st Floor
Green Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten

I. REQUESTOR & SURVEYOR INFORMATION

 1. Requestor Name :
2. EMR Department : Market Planning & Acquisition
3. Contact Phone Number :

II. SURVEYOR INFORMATION

1. Survey Date : 16 January 2023

2. Surveyor Name : Alfian

3. Survey Company : Eka Mas Republik

4. Contact Phone Number : 081232136513

III. SITE INFORMATION

1. Site Location Name Perumahan Kartoharjo Indah
:
2. Site Location Address : Jl. Raya Kelun, Kelun

3. Site Coordinates : -7.603622, 111.553618

: 1. --
4. Site Location PIC/Phone Number
: 2. --

5. PKS Status : ✓Done Not Done

6. Survey Map : ✓ Hardcopy✓ Softcopy

HP OK :416 HP
HP RK :13 HP
HP RR :8 HP
7. Home Pass and Occupation : Total Homepass : 404 HP HP TK :1 HP
HP UH :7 HP
HP Covered by MR :445 HP
9. Network Topology : FTTH / FTTB / HFC**(Delete as applicable)

10. Service Type Delivered : TV / Internet / Voice / Triple Play* *(Delete as applicable)

11. Construction Type : SEWER *| AE / UG* *(Delete as applicable)

12. Existing Provider Network : Yes /No* | FTTH / FTTB / HFC*| SEWER / UG / AE * *(Delete as
applicable)

13. Existing Provider Name : Indihome, RT/RW Net, Wifi Kota

14. Survey Result & Note :

Survey Result & Note :

Telah dilakukan Survey tanggal 16 January 2023 terhadap cluster Perumahan Kartoharjo Indah
Distribusi,dengan keterangan sebagai berikut :

PT. EKA MAS REPUBLIK

MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
 1. Tarikan Kabel distribusi dibagi menjadi 3 Line dengan masing masing kabel
Line A:24 core
Line B:24 core
Line C : 36 core
Untuk Line A memasang FAT sebanyak 12 FAT ( Aerial ) , Untuk Line B memasang FAT sebanyak 9
FAT, Untuk Line C memasang FAT sebanyak 14 FAT

1. Total Tiang New Proposed sebanyak 85 Unit ( Distribusi 73 unit , tiang home connect 17 unit )
2. Total homepass yang tercover adalah 445 Homepass.

Note : Site information shall refer to IMI Request For Survey Form released.

IV. GUIDANCE MAP / GOOGLE EARTH

SATELLITEPHOTO OF LOCATION

V. PHOTOS OF SITE ACTUAL CONDITION(Note : Photo size shall not exceed more than 500 kB)

PT. EKA MAS REPUBLIK

MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
 MAINT GATE TO SITE LOCATION ACTUAL SITE LOCATION

ACTUAL SITE LOCATION ACTUAL SITE LOCATION

I. PHOTOS OF SITE ACTUAL CONDITION(Note : Photo size shall not exceed more than 500 kB)

PT. EKA MAS REPUBLIK

MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten
 ACTUAL SITE LOCATION ACTUAL SITE LOCATION

II. SIGN & CHECK MATRIX

SURVEY COMPANY PIC–EMR SURVEYOR /DEVELOPER /COMMUNITY

Name : Name : Alfian

Date : Date :

PT. EKA MAS REPUBLIK

MyRepublic Plaza 1st FloorGreen Office Park 6 Grand Boulevard
BSD - Tangerang Selatan
15345 Banten