Lampiran 3 yang disubkon

+,-',. /,0 ,

1 1. ,, 2, 0 +

/ 3 '.,

,

!
" !

#

$
" !

'

%

&

&

(
)

*

" #

"

"

..............................................., .......................... 2012
Penawar,
PT/ CV......................................................

Tanda Tangan, Cap

( Nama Jelas )
Direktur