Lampiran 3 yang disubkon

)*+$*, -*. *

!

/ /, ** 0* . ) (1- 2 $,*

- 3 %! &

( (

4

,

5

*

3 36 7" 8 1

"


!

"

#"

$

#"

%
&

'

!

(!


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

Tanda Tangan, Cap

( Nama Jelas )
Direktur