Confidential Property

ofEMRPassive Network
Planning

TECHNICAL SITE SURVEY REPORT

Complex/Cluster/Building
Kanigoro RW 11
Name
Site Address

Hub Plan Name MADIUN

OLT / Sub Hub Plan Name MADIUN

Survey Date 19 JANUARY 2022

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 : 19 February 2023

2. Surveyor Name : Alfian

3. Survey Company : Eka Mas Republik

4. Contact Phone Number : 081232136513

III. SITE INFORMATION

1. Site Location Name Kanigoro RW 11
:
2. Site Location Address : Jl. Ronggo Tohjoyo, Kanigoro

3. Site Coordinates : -7.632450, 111.541936

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

5. PKS Status : ✓Done Not Done

6. Survey Map : ✓ Hardcopy✓ Softcopy

HP OK :330 HP
HP RK :15 HP
HP RR :11 HP
7. Home Pass and Occupation : Total Homepass : 449 HP HP TK :98 HP
HP UH :10 HP
HP Covered by MR :449 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

14. Survey Result & Note :

Survey Result & Note :

Telah dilakukan Survey tanggal 19 January 2023 terhadap Kanigoro RW 11

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 1 Line dengan masing masing kabel
Line A:36 core

2. Untuk Line A memasang FAT sebanyak 13 FAT ( Aerial )

3. Total Tiang New Proposed sebanyak 103 Unit (Distribusi 90 unit , tiang home connect 9 unit, tiang
Crosing Jalan raya 4 unit )
4. Total homepass yang tercover adalah 449 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)

MAINT GATE TO SITE LOCATION ACTUAL SITE LOCATION

PT. EKA MAS REPUBLIK

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