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CIDB L1_96

CIDB L1_96

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Borang/ Form CIDB L1l96 ( Pindaan 1/03 )

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Pembinaan Malaysia Industri Lembaga Pembangunan
Avenue, No.72, Pahang, 7, Jalan 53000Kuala Lumpur. lbu Pejabat Tingkat GrandSeasons CIDB, p.o.e6x. tzzta, sollz KualaLumpur. 603 4044 8808.Fax: Tel: 603 +oaszaoa http://www.cidb.gov.my

S I P F .C"O N S T R U C T I O N I N D U S T R Y D E V E L O P M E N T B O A R D M A L A Y S I A ,

PEMBERITAHUAN KERJAPEMBINAAN BORANG FORMOF COTVSTRUCTION WORK NOTIFICATION
Pada Menjalankan Kuasa Di Bawah Seksyen 27 Akta Lembaga Pembangunan Industri Pembinaan Malaysia 1994 In Exercise Of The Power Conferred By Section 27 Of The Lembaga Pembangunan lndustri Pembinaan Malaysia Act 1994

Untuk Kegunaan Pejabat For offtce use No. Pendaftaran Projek : Project Registration No : Kategori Projek : Prclect Category: Sektor: Secfor: 1 BUTIR.BUTIR KONTRAKTOR / CONTRACTOR'SDETA'LS 1.1 Nama KontraKor: Contractotos Name '1.2 No. Pendaftaran CIDB : C/D8's Regisfiation No

1 . 3 Alamat Surat Menyurat (iika ada perubahan) :
Conespondence Address (ifthere is any changes)

1.4 No. Tel : TeL No.

1.5 No. Fax : Fax No.

1.6 E-Mail:

2

BUTIR-BUTIRTAWARAN KERJA KONTRAK I CONTRACT OF AWARD WORKS DETAILS

2 . 1 .Nama Pemilik / Klien (iika sub-kontraktor,namakan kontraktor utama) :
Name of Owner / Client (ff sub-contractor, name the main contractor)

2.2. Tajuk Kerja Pembinaan :
Title of the Contruction Works (s)

2.3. Nilai Konlrak/ Kerja (RM) : Value of the Contract / Work (MR)

2.4. Tarikh Surat Tawaran*: Date of Award Letter

2.5 Jenis Kontrak (Iandakan 'X) :
Contract Type (Tick X)

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2.6 KaedahBayaranKerja ((Tandakan'X'):
Term of Work Payment (Tick X)

MengikutPeringkatKemajuanKerja | Progrcss Payment B"y"r"n Berjadual | SchedulePayment Bayaran Setelah Siap Keria Payment After Work Complete KontrakUtama Main Contract Sub Kontrak Sub Contract

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BayaranTertangguh Defered Payment Lain-Lain(nyatakan): Otherc (please state)

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KategoriKontrak(Tandakan'X'): Contract Category ffick'x)

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Suu KontrakDinamakan [--l | | NominatedSub Contnct' Sub KontrakBuruh Labour Sub Contract

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000 katilI 1.7 jika ruang tidak mencukupi) Nama dan Alamat SyarikatPerunding (gunakanlampiran : ConsultantCompany's Name and Address (use additional attachment) Perunding Arkitek Architecture Consultanl PerundingKejuruteraan Awam / Struktur Civil / Structure Engineer Consultant PerundingKejuruteraan Mekanikal & Elektrikal Mechanical & Electrical Engineer Consultant PerundingUkur Bahan Quantity Surveying Consultant Lain-lain Ofhers Saya dengan ini mengakubahawa maklumatyang diberikandi atas adalahbenar dan lengkap.000.000 50.3 Tarikh*Siap Sebenar/ *Jangkaan Disiapkan: *Actual Completion / *Expected Completion Date r-Naiktaraf T--l Pembesaran | Expension | . I hereby declare that the information given above is true and complete.000 20.-1 l_l Penyelenggaean Maintanence e.6 Nama KomponenProjekPembinaan Name of ConstructionProject Component Jawatan I Designation: Saiz I Size (bilangan/ keluasan/ panjangdan unit fungsi) (number / area / Iength and functional unit) 10.000bed 30 bilik darjah | 30 class room Kos / Nilai (RM) Cost / Value (MR) 1 Balai Raya I Public Hall 2 MasjidI Mosque 3 Jalan Kampung I Village Road 4 Kuater Kelas G / C/ass G Quafters 5 Hospital 6 SekolahI School 80.000 18.000jemaah I 3.6) Construction Work Size (if mix4evelopment pleaseproceed to section3.77 .000m' 3.000 Nota / Note : ' Sifa kepifkan safinan Surat Tawaran/ pesanan I inden I Pleaseaftach a @py of Awad Lettar/ otder / indent " Potong mana yang tidak berkenaanI Deletewhicheverinapplicable yang berdaftardi bawahAkta CIDB hendaklahmengemukakan Kontraktor maklumatkepada CIDB mengenaiapa-apakerja pembinaanbaru yang diawardkandalam tempoh empat belas (14) hari dari pengawardanitu.000 1. [-l New Proiect l-J / l-l | e"ik Putih Penggantian | Repair/Replacement I lupgraaing ftsn6y6tsn l-luuansuai l-J 3 . Tarikh/ Dafe : Tandatangan Kontraktor Wakil** / Signature of Contractor/ Representative contractof" of Cop Rasmi Kontraktor: Contractor'sOfficial Stamp N a m a/ N a m e : Huruf Besar / CaDital Letter Contoh untuk ruangan 3.000.6) (bilangan keluasan/ panjangdan unit fungsi) / (number / area / length and functional unit) 3 .4 Jenis Kerja (Tandakan : Work Type (Tick'x) 3.000.2 Tarikh**MulaSebenar/ *Jangkaan Dimulakan: **Actual Stafted / *'Expected Stafted Date 'x') 3. 5 Saiz Kerja Pembinaan: (jika pembangunan bercampurterus ke ruangan3. 6 Untuk DiisiJika ProjekPembangunan Bercampur(gunakanlampiranjika ruangtidak mencukupi): To Be Filled If Mix-Development Project (use additional attachment) Nama KomponenUtama ProjekPembinaan Name of Construction Project Main Component (Lihat contoh di bawah I See example below) Saiz / Sl2e (bilangan keluasan/ panjangdan unit fungsi) / (number / arca / length and functional unit) Kos / Nilai (RM) Cost/ Value (RM) 3.000. A contractorregistered under the Act shall submit information to CIDB on any new constructionwofus awarded within fourteen (14) days of the award.6 I Example for section 3. 1 Alamat PenuhTapakKerja Pembinaan: Address of the Site of Construction Work(s) 3.000 500.000 people 2km 4 unit 1.y"t s"r.000m' | 10.3 BUTIR-BUTIRKERJA PEMBINAAN/ CONSTRUCTION WORK DETAIL 3 .

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