CHANGE REQUEST FORM

* = Mandatory
REQUEST TIME
* Submission Date (no later than 3
July 22, 2020 Time CRF NO
working days before execution)
PLANNED WORK CONTACT
* Requestor Name Dwi Indarto Function NPI EJ Signature
Deded Afridoni/088210037881 ZTE-Tech Mgr
Function
* Technical Assessor Name Signature

Dwi indarto / 08815000197 NPI EJ

Iffan Choirulanwar/ 0888309696 ZTE

* Implementer Name Function Signature

Sugeng Mujiharto / 08811210817 NPI EJ

Dwi indarto / 08815000197 NPI EJ
* PM/PIC (SMART) Function Signature
Hardian Boby Arifianto / 08881852302 NPI EJ

ORDER DETAIL
* Impact Activity (identify whether
NSA
SA or NSA)
* Severity (High / Low) LOW
Category Integrasi site low revenue
Type of Work/Activity
Activity Integrasi site low revenue
Network Element BTS
Priority Normal
* Location Address East Java

Site ID / Number See the Site List

Bypass Billing Yes

Not
N/A V

* Change Description (Reason) Integrasi site low revenue

* Services Impacted / Outage (N/A if

NSA
no services impacted)
* Other impact (pls include
potential services / activities
N/A
impacted after the work has been
done)
* MOP Description (Please include
Refer to attached MOP & Plan and Site Impact sheets
duration and PIC of each step)
* General description of testing
Refer to attached MOP
required (pls attach detail)
* Contingency Plan (please include
N/A
contingency PIC at EXCOM level)
* List of Affected
Refer to Plan and Site Impact sheets
Equipment and Circuits
Outage (if SA) window is only from 00:30 to 04:00 (including testing & contingency plan)

* Schedule Date Start July 31, 2020 End August 31, 2020
* Schedule Time Start 6:00 End 18:00

2576/CR/ST/XI/10
Outage Date Start - End -
Outage Time Start - End -
Reschedule Date Start End
Reschedule Time Start End
APPROVAL SHEET
Include system owners Sign Off
NO DATE NAME DESIGNATION APPROVAL DECISION
1
2
3
4
5
6
7
POST ACTIVITY REVIEW
Actual Downtime

CRF Result

Post Activity Observation

Corrective Action (for

unsuccessful activity)

CERITIFIED BY

NO DATE NAME DESIGNATION

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

2576/CR/ST/XI/10
2576/CR/ST/XI/10
SIGNATURE

SIGNATURE

2576/CR/ST/XI/10
No Vendor ID Site Name SOW TX Equipment
1 ZSBY_2772 RAYAKEMASANTSEL Sales Relocation 23G_IP-20C_200_0.3-0.3_1+0
 Link ID PEL Remark
ZSBY_2772-ZSBY_1535
 MNG
SF ID PLAN
VLAN IP GW
ZSBY_2772 TDD&FDD 1500 172.28.189.118 172.28.189.117
 TDD
SUBNETMASK VLAN IP GW SUBNETMASK VLAN
255.255.255.252 1501 172.29.2.118 172.29.2.117 255.255.255.252 1502
 FDD
IP GW SUBNETMASK IPRAN Name
172.29.71.118 172.29.71.117 255.255.255.252 SBY_6120H_ZSBY_1535
 Site ID Site Name BBU Board RRU TDD
BPQ2 (1 pcs)
CCE1B (1 pcs)
ZSBY_2772 RAYAKEMASANTSEL ZXSDR B8200 3xR8978
PM5 (2 pcs)
SA (1 pcs)
RRU FDD Rectifier Antenna

DDW4-6590D-R3
3xR8862A ZTE ZXDU68 W201 V5.0
Commscope 12 Port
Vendor ID SF SITE ID Technology Cell Cell ID Enode ID City
ZSBY_2772 ZSBY_2772 TDD+FDD 11 ZSBY_2772_11 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 12 ZSBY_2772_12 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 13 ZSBY_2772_13 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 21 ZSBY_2772_21 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 22 ZSBY_2772_22 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 23 ZSBY_2772_23 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 31 ZSBY_2772_31 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 32 ZSBY_2772_32 307772 Surabaya
ZSBY_2772 ZSBY_2772 TDD+FDD 33 ZSBY_2772_33 307772 Surabaya
 Long Lat Azimuth Etilt Mtilt PCI RSI Ncs Prach Index TAC
112.656256 -7.35577 50 2 0 432 650 8 4 3012
112.656256 -7.35577 190 2 0 433 654 8 4 3012
112.656256 -7.35577 250 2 0 434 658 8 4 3012
112.656256 -7.35577 50 2 0 432 650 8 4 3012
112.656256 -7.35577 190 2 0 433 654 8 4 3012
112.656256 -7.35577 250 2 0 434 658 8 4 3012
112.656256 -7.35577 50 2 0 438 698 10 5 3012
112.656256 -7.35577 190 2 0 439 704 10 5 3012
112.656256 -7.35577 250 2 0 440 710 10 5 3012
Ant Height(M) ME ID USER LABLE Rs Power Tech Clutter Unique
40 307772 ZSBYDM2772-11 18.2 TDD Sub Urban ZSBY_2772TDD
40 307772 ZSBYDM2772-12 18.2 TDD Sub Urban ZSBY_2772TDD
40 307772 ZSBYDM2772-13 18.2 TDD Sub Urban ZSBY_2772TDD
40 307772 ZSBYDM2772-21 18.2 TDD Sub Urban ZSBY_2772TDD
40 307772 ZSBYDM2772-22 18.2 TDD Sub Urban ZSBY_2772TDD
40 307772 ZSBYDM2772-23 18.2 TDD Sub Urban ZSBY_2772TDD
40 307772 ZSBYDM2772-31 18.2 FDD Sub Urban ZSBY_2772FDD
40 307772 ZSBYDM2772-32 18.2 FDD Sub Urban ZSBY_2772FDD
40 307772 ZSBYDM2772-33 18.2 FDD Sub Urban ZSBY_2772FDD
 SOW
Sales Relocation
Sales Relocation
Sales Relocation
Sales Relocation
Sales Relocation
Sales Relocation
Sales Relocation
Sales Relocation
Sales Relocation
 Link ID IP address NE IP address FE Subnetmask
ZSBY_2772-ZSBY_1535 10.34.210.99 10.34.210.98 /29

Subnet IP Link IP IDU

10.34.210.96 Network
10.34.210.97 Gateway (di IPRAN)
10.34.210.98 ZSBY_1535-ZSBY_2772 FE
10.34.210.99 ZSBY_2772-ZSBY_1535 NE
/29
10.34.210.100
10.34.210.101
10.34.210.102
10.34.210.103 Broadcast
 Gateway Vlan range Vlan IPRAN
10.34.210.97 651 651 SBY_6120H_ZSBY_1535

Router VLAN Remarks

SBY_6120H_ZSBY_1535 651
20240111_SALES RELOCATION
SBY_6120H_ZSBY_1535 651
20240111_SALES RELOCATION
 Equipment Remark
23G_IP-20C_200_0.3-0.3_1+0
Site_ID Site_Name Lat Long Tech Project Nds_Ip
ZSBY_2772 RAYAKEMASANTSEL -7.35577 112.656256 TDD-FDD Sales Relocation 10.16.157.132
access required SBY_6120H_ZSBY_1535
SBY_6120H_ZSBY_1535 !<if-intf>
interface gei-1/1/0/2.651
description MW_ZSBY_2772
ip vrf forwarding NMS
ip address 10.34.210.97 255.255.255.248
Alokasi: $
IPRAN port gei-1/1/0/3 !</if-intf>
!<vlan>
vlan-configuration
interface gei-1/1/0/2.651
encapsulation-dot1q 651
$
$
!</vlan>

!<if-intf>
interface gei-1/1/0/2.1500
description NMS-ZSBY_2772
ip vrf forwarding NMS
ip address 172.28.189.117 255.255.255.252
$
!</if-intf>
!<vlan>
vlan-configuration
interface gei-1/1/0/2.1500
encapsulation-dot1q 1500
$
$
!</vlan>

!<if-intf>
interface gei-1/1/0/2.1501
description TDD-ZSBY_2772
ip vrf forwarding LTE_S1
ip address 172.29.2.117 255.255.255.252
$
!</if-intf>
!<vlan>
vlan-configuration
interface gei-1/1/0/2.1501
encapsulation-dot1q 1501
$
$
!</vlan>

!<if-intf>
interface gei-1/1/0/2.1502
description FDD-ZSBY_2772
ip vrf forwarding LTE_S1
 ip address 172.29.71.117 255.255.255.252
$
!</if-intf>
!<vlan>
vlan-configuration
interface gei-1/1/0/2.1502
encapsulation-dot1q 1502
$
$
!</vlan>
BY_1535
Rollback
no interface gei-1/1/0/2.651
no interface gei-1/1/0/2.1500
no interface gei-1/1/0/2.1501
no interface gei-1/1/0/2.1502