KEMENTERIAN PERDAGANGAN

BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

No : 094/BAPC/09/2019
Tanggal, date : September 22, 2019

I, the undersigned below, as the Sampling
Officer assigned by Product Certification
Body PPMB, and witnessed by the Company
Representatives, declare that I have
conducted the sampling of product related to
product certification process, with necessary
information as followings :
Saya, yang bertanda tangan dibawah ini selaku
Petugas Pengambil Contoh yang ditugaskan oleh
Balai Sertifikasi, dan disaksikan oleh Wakil
Perusahaan, menyatakan bahwa telah melakukan
pengambilan contoh terkait proses sertifikasi
produk, dengan informasi sebagai berikut:

I. Informasi Umum, General Information

1. Nama Perusahaan, Company : Jiangmen Shunjing Lighting Co., Ltd
Name
2. Alamat Perusahaan, Company : Workshop Floor 1, 2, 3 Building 4 No. 33 Gaoxing East
Address Road, Jianghai District, Jiangmen city, Guangdong
Province, P.R. China 529000
3. Tanggal Pengambilan Contoh, : September 22, 2019
Date of Sampling
4. Lokasi Pengambilan Contoh, : FINISHED WAREHOUSE
Location of Sampling
5. Metode Pengambilan Contoh, : Random
Sampling Method
6. Acuan Pengambilan Contoh, : Dpi-01-02-90.1(LUMINAIRES)
Sampling Reference
7. Petugas Pengambil Contoh, : Ahmad Fasya
Sampling Officer

II. Contoh Produk yang Diambil. Product being sampled

1. Kode Contoh : 001/094BAPC/09/2019
Sample Code
Standar Produk : SNI IEC 60598.1:2016 & SNI IEC 60598.2.2:2016
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Recessed Luminaires
Type of Product
Spesifikasi; Model; Merek : 12 W/ 220-240 V/ 50-60 Hz / DL-688 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Jumlah Contoh Produk yang Diambil : 6 pcs

Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 3W, 5W, 6W, 7W, 8W, 9W, 15W, 18W, 20W, 24W,
Spesifikasi; Model; Merek 36W, 48W/ 220-240 V/ 50-60 Hz / DL-2002, DL-
Representative for specification, model, brand 3002, DL-4002, DL-5002, IB-100R, DL-120R, DL-
170R, DL-225R, DL-100S, DL-120S, DL-170S, DL-
225S, DL-588, DL-688, DL-788, DL-888 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

2. Kode Contoh : 002/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.2:2016
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Recessed Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 50 W/ 220-240 V/ 50-60 Hz / SA536 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Batch. No/ Production Date

Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 2W, 3W, 5W, 10W / 220-240 V/ 50-60 Hz/ SA533,
Spesifikasi; Model; Merek SA535, SA5011, SA5033, SA5022, SA029S, SA030S,
Representative for specification, model, brand SA8040, SA8041, SA35, SA36, SA37, SA38,SA 6575, SA
6661, SA 6601, F 100, F 106, SA 08, SA 06, SA 09, SA
03, SA 04, SA 05, SA 07 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

3. Kode Contoh : 003/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI 04-6973.2.1:2005
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Fixed General Purpose Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 50 W/ 220-240 V/ 50-60 Hz / SA-215 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Batch. No/ Production Date

Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 3W, 5W, 7W, 10W, 12W, 15W, 18W, 20W, 30W, /
Spesifikasi; Model; Merek 220-240 V / 50-60 Hz / SA-672, SA-673,SA-674, SA-
Representative for specification, model, brand 676, SA-677, SA-679, SA-695, SA-2056C,SA-2057C,
SA-2058C, SA-040, SA-044, SA-048, SA-0013, SA-30,
SA-40, SA-111, SA-112, SA-222, SA-205, SA-641,SA-
2023A , SA-2050, SA-2052, SA-2012, SA-209, SA-210,
SA-263, SA-265, SA-266, SA-267, SA-360, SA-362, SA-
363, SA-214K, SA-360K, SA-216, SA-217, SA-218/
FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

4. Kode Contoh : 004/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.5:2016
Standard of Product
Produk : LUMINAIRES
Product
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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Jenis Produk : Floodlight

Type of Product
Spesifikasi ; Model; Merek : 30 W/ 220-240 V/ 50-60 Hz / SA-5730 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 10W, 20W, 50W, 100W, 150W, 200W, 250W, 300W,
Spesifikasi; Model; Merek 400W, 500W, 600W, 1000W, 1200W, 1500W, 2000W
Representative for specification, model, brand / 220-240 V/ 50-60 Hz / SA-2002, SA-2003, SA-5730,
SA-3030, SA-810, SA-820, SA-830, SA-850, SA-8150,
SA-8200, SA-510, SA-520, SA-530, SA-550, SA-320,
SA-2835, SA-7070, SA-707, SA-7072, SA-7870, SA-
8080, SA-8081, SA-8082, SA-8083, SA-8084 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

5. Kode Contoh : 005/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.2:2016
Standard of Product
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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Produk : LUMINAIRES
Product
Jenis Produk : Recessed Luminaires
Type of Product
Spesifikasi ; Model; Merek : 24 W/ 220-240 V/ 50-60 Hz / OB-888 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 3W, 6W, 9W, 10W, 12W, 14W, 16W, 18W, 20W, 30W,
Spesifikasi; Model; Merek 36W, 72W / 220-240 V / 50-60 Hz / OB-333, OB-555,
Representative for specification, model, brand OB-666, OB-777, OB-999, H45, H46, SA2018, F 7118,
F 7218, F 7136, F 7236, SA2016, SA2017, SA2019,
SA2013 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

6. Kode Contoh : 006/094BAPC/09/2019

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Sample Code
Standar Produk : SNI IEC 60598.1:2016 & SNI IEC 60598.2.2:2016
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Recessed Luminaires
Type of Product
Spesifikasi; Model; Merek : 2x5 W/ 220-240 V/ 50-60 Hz / SA80 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 3W, 10W, 40W, 60W, 80W / 220-240 V/ 50-60
Spesifikasi; Model; Merek Hz/ SA 924, SA 89P, SA 80P, SA 86P,SA 81P,
Representative for specification, model, brand SA140, SA141, SA 142, SA 420, SA 425, SA 430,
SA 450, SA 520, SA-530, SA82, SA83, SA84, SA86,
SA87, SA88, L901, L902, L903, L905, L906,
L907, SA8012, SA8013 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

7. Kode Contoh : 007/094BAPC/09/2019

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI 04-6973.2.1:2005
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Fixed General Purpose Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 40 W/ 220-240 V/ 50-60 Hz / SA 4304S /
Specification; Model; Brand FATRO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 6W, 12W, 18W, 24W, / 220-240 V/ 50-60 Hz /
Spesifikasi; Model; Merek SA8015, SA8016, SA8017, SA7092, SA001, F002,
Representative for specification, model, brand F003, F004, F005, F006, F008, F009, F011, F012,
F013, SA014, SA015, SA8051, SA8055, SA222,
SA223, SA225, SA226, SA4019, SA4018, SA102,
SA103, SA105, SA1102, SA002, SA112, SA
4301S, SA 4302S, SA 4304S, SA 4305S, SA 3033,
SA 3034, SA 3035, SA 3036, SA 3037, SA 3038,
SA601, SA602, SA603, SA604, SA605, SA606, SA
5001-1, SA 5001-2, SA 5001-3/ FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

8. Kode Contoh : 008/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.3:2016
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Luminaires For Road And Street Lighting
Type of Product
Spesifikasi ; Model; Merek : 50 W/ 220-240 V/50-60 Hz / SA 7001 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : 8W, 10W, 12W, 15W, 20W, 24W, 25W, 30W,
Spesifikasi; Model; Merek 36W, 42W, 52W, 60W, 70W, 80W, 84W, 98W,
Representative for specification, model, brand 100W, 112W, 126W, 120W, 150W, 200W,
250W/ 220-240 V/50-60 Hz / SA2006,
SA2006S, SA 2007, SA 2005, SA 2005S, SA 7001,
SA 7004, SA 7005, SA 7008, M 6002, SA 8001, SA

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

8002, SA 8003, SA 8005, SA 8006, SA 8007, SA

8008 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

9. Kode Contoh : 004/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.5:2016
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Floodlight
Type of Product
Spesifikasi ; Model; Merek : 30 W/ 220-240 V/ 50-60 Hz / SA-5730 / FATRO
Specification; Model; Brand
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 50 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Arsip Contoh Disimpan di : Pabrik

Sample Spare is kept in
Mewakili : 10W, 20W, 50W, 100W, 150W, 200W, 250W,
Spesifikasi; Model; Merek 300W, 400W, 500W, 600W, 1000W, 1200W,
Representative for specification, model, brand 1500W, 2000W / 220-240 V/ 50-60 Hz / AR
350, AR 352, AR 354, SA 250, SA 252, SA 254, ZT
031, ZT 032, ZT 033, ZT 034, ZT 035, SA 671, SA
681, SA 5002, SA 5003, SA 5001, SA 4001 A, SA
4001 B, SA 8070, SA 8071, SA 9070, SA 9071, SA
6070, SA 6071, SA 5005, SA 5006, SA 5007, SA
3704, SA 3705, SA 005, SA 009, SA 9501, SA
9502, SA 255, SA 256, SA 4015, SA 4014, SA
8064, SA 1002, SA 1001, SA 2003, SA 2002, SA
2001, SA 9503, SA 9504 / FATRO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

10. Kode Contoh : 010/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.4:2012
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Portable Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 40 W/ 220-240 V/50-60 Hz / MT-2003/
Specification; Model; Brand VASINDO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Jumlah Total Populasi Produk : 6 pcs

Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : Maks. 40W / 220-240 V/50-60 Hz / MT-3008,
Spesifikasi; Model; Merek MT-2007,MT-2009,MT-2022,MT-2026,MT-
Representative for specification, model, brand 2027,MT-2028,MT-2030,MT-2037,MT-2038,MT-
2077,MT-2078,MT-3056,MT-8868,MT-1036,MT-
1091,MT-6027,MT-6046,MT-6059,MT-901,MT-
945,MT-946,MT-169,MT-210,MT-3010,MT-
2003,MT-3009,MT-3309,MT-3693,MT-3719,MT-
601,MT-817,MT-9013,MT-9015,MT-9017,MT-
9018,MT-9019,MT-1122,MT-1125,MT-2010,MT-
2013,MT-2014,MT-2015,MT-2019,MT-2020,MT-
2025,MT-2033,MT-2035,MT-2036,MT-8203,MT-
8206,MT-8208,MT-8209,MT-8222,MT-8223,MT-
8224,MT-8225,MT-8226,MT-8227,MT-8228,MT-
8229,MT-616,MT-6284,MT-6596,MT-6604,MT-
6271,MT-6272,MT-6276,MT-6277,MT-6278,MT-
6279/ VASINDO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

11. Kode Contoh : 011/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI IEC 60598.2.4:2012
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Portable Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 40 W/ 220-240 V/50-60 Hz / ML-817/
Specification; Model; Brand VASINDO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 6 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : Maks. 40W / 220-240 V/50-60 Hz / ML-8868,
Spesifikasi; Model; Merek ML-210, ML-3309, ML-601, ML-6027, ML-6046,
Representative for specification, model, brand ML-6059, ML-820, ML-821, ML-822, ML-835,
ML-9013, ML-9017, ML-9018, ML-9019, ML-
945, ML-6284, ML-6271, ML-6272, ML-6276,
ML-6277, ML-6278, ML-6279, VAS-0012, VAS-
1030, VAS-1440, VAS-1523 ,VAS-1533, VAS-
3188, VAS-438, VAS-6256,VAS-6286,VAS-
6291,VAS-6351,VAS-6352, VAT-6460,VAT-
666,VAT-668,VSJ-902, VSJ-9025, VSJ-903,VSJ-
904,VSJ-9059,VSJ-9080, VSJ-9097, VSJ-9101,VSJ-
9167,VSJ-9258,VSJ-9261, VSJ-9262,VSJ-
9266,VSJ-9271,VSJ-9272/ VASINDO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

12. Kode Contoh : 012/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI 04-6973.2.1:2005
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Fixed General Purpose Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 40 W/ 220-240 V/50-60 Hz / VSW-2172 /
Specification; Model; Brand VASINDO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 6 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : Maks. 40W/ 220-240 V/50-60 Hz / VSW-
Spesifikasi; Model; Merek 3109,VSW-3167,VSW-3191,VSW-3801, VSW-
Representative for specification, model, brand 3802, VSW-3803,VSW-9007,VSW-5589, VSW-

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

5282, VSW-508,VSW-5806,VSW-8820, VSW-

8868,VSW-2172,VSW-2083,VSW-9207, VSW-
8271,VSW-9011,VSW-9068,VSW-9028, VSW-
9092,VSW-9090,VSW-9105,VSW-9811, VSW-
9857,VSW-9864,VSW-9919,VSR-812,VSR-823,
VSR-825,VSR-872,VSR-873,VSR-877,VSR-8826,
VSR-895,VSR-897,VSR-9004,VSR-9016,VSW-
0069,VSW-1050,VSW-11017,VSW-11021,VSW-
11035,VSW-1622,VSW-2007,VSW-2008,VSW-
20112,VSW-2013,VSW-2015,VSW-20151,VSW-
20152,VSW-20153,VSW-20154,VSW-20155,
VSW-2028, VSW-2042,VSW-2043,VSW-2046,
VSW-2048,VSW-2055,VSW-2073,VSW-2076,
VSW-2077,VSW-2078,VSW-2079,VSW-2087,
VSW-2213,VSW-2236,VSW-2331,VSW-2355,
VSW-2377,VSW-2660,VSR-1015,VSR-1033,VSR-
8826, VSW-3033,VSW-351,VSW-352,VSW-
353,VSW-355,VSW-358,VSW-6056,VSW-6070,
VSW-6082,VSW-6083,VSW-6085,VSW-6088,
VSW-6093,VSW-7521,VSW-8003,VSW-8026,
VSW-8725,VSW-8729,VSW-8832,VSW-9012,
VSW-9013,VSW-9847,VSM-325,VSM-331,VSM-
332,VSM-338,VSM-339,VSR-SZ,VSW-5011,VSW-
5015,VSW-5019,VSW-5025,VSW-1059,VSW-
1060, VSW-1061,VSW-1062,VSW-1063,VSW-
1064, VSW-1065,VSW-1066,VSW-1067,VSW-
1068, VSW-1069,VSW-1070,VSW-1071,VSW-
1072, VSW-1073,VSW-1074,VSW-1075,VSW-
1076, VSM-9085,VSM-8253,VSM-8081,VSM-
8829, VSM-137,VSM-013,VSM-8082,VSM-8083,
VSM-8084,VSM-8085,VSR-9699,VSR-9908,VSR-
1111, VSR-A005,VSR-A006,VSW-7761,VSW-
7811, VSW-7812,VSW-7813,VSW-7814,VSW-
7815, VSW-7816,VSW-7121,VSW-7122,VSW-
7123, VSW-7124,VSW-7125/ VASINDO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

13. Kode Contoh : 013/094BAPC/09/2019

Sample Code
Standar Produk : SNI IEC 60598.1:2016 & SNI 04-6973.2.1:2005
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Fixed General Purpose Luminaires
Type of Product
Spesifikasi; Model; Merek : Maks. 120 W/ 220-240 V/50-60 Hz / VSC-1004 /
Specification; Model; Brand VASINDO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 6 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : Maks. 120W / 220-240 V/50-60 Hz / VSC-
Spesifikasi; Model; Merek 1004,VSC-1011,VSC-1013,VSC-1014,VSC-
Representative for specification, model, brand 1032,VSC-1034,VSC-1039,VSC-1040,VSC-
1043,VSC-1044, VSC-1017,VSC-5104,VSC-
5105,VSC-5112,VSC-5113,VSC-7101,VSC-
7106,VSC-673,VSC-802,VSC-804VSC-805,VSC-
906,VSC-907,VSC-177,VSC-179,VSC-1010,VSC-

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

1057,VSC-1068,VSC-1069,VSC-1086,VSC-1087,
VSC-1089,VSC-1090,VSC-1098,VSC-1099,VSC-
11137,VSC-11150,VSC-11151,VSC-11153,VSC-
11155, VSC-1221, VSC-1222,VSC-1253,VSC-1369,
VSC-1565,VSC-1640,VSC-1641,VSC-1642,VSC-
1643,VSC-1648,VSC-1907, VSC-1910,VSC-1909,
VSC-2078,VSC-2097,VSC-3242,VSC-3780,VSC-
501,VSC-6008,VSC-6010,VSC-6012,VSC-
6621,VSC-6625,VSC-6623,VSC-6627,VSC-
6628,VSC-6633, VSC-6636,VSC-6681,VSC-
6713,VSC-6723,VSC-6725,VSC-6726,VSC-
6867,VSC-6972,VSC-702,VSC-8161,VSC-
8173,VSC-8176,VSC-8235,VSC-8506, VSC-
8510,VSC-8607,VSC-8608,VSC-88016,VSC-
9153,VSC-9203,VSC-9218,VSC-9219,VSC-9221,
VSC-9222,VSC-9223,VSC-6108,VSC-6109,VSC-
D01,VSC-D02,VSC-D03,VSC-D04,VSC-D05,VSC-
D06,VSC-D07, VSC-D08,VSC-D09,VSC-D10,VSC-
D11,VSC-D12,VSC-D13,VSC-8068,VSC-8112,VSC-
8121,VSC-8123,VSC-8129,VSC-8809,VSC-9008,
VSC-9024,VSC-86616,VSC-86619,VSC-9118,VSC-
9119,VSC-9127,VSC-9128, VSC-9077,VSC-9089,
VSC-9090,VS-578,VS-610,VS-611,VS-612,VS-
1528, VS-1529,VS-2385,VS-2386,VS-2387,VS-
2388,VS-2389, VS-528,VSC-1101,VSC-150,VSC-
151,VSC-160, VSC-161,VSC-180,VSC-205,VSC-
206, VSC-503 ,VSC-809,VSC-906,VSC-908,VSC-
9081,VSC-909 / VASINDO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

14. Kode Contoh : 014/094BAPC/09/2019

Sample Code
Standar Produk :
SNI IEC 60598.1:2016 & SNI 04-6973.2.1:2005
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Fixed General Purpose Luminaires
Type of Product
Spesifikasi ; Model; Merek : Maks. 120 W/ 220-240 V/50-60 Hz / T-118 /
Specification; Model; Brand VASINDO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 6 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : Maks. 120W/ 220-240 V/50-60 Hz / T-104,T-
Spesifikasi; Model; Merek 108,T-109,T-110,T-112,T-115,T-116,T-117,T-
Representative for specification, model, brand 119,T-120,T-121,T-122,T-123,T-125,T-126, T-
127, T-128, T-129, T-130,T-131,T-132,T-133,T-
134,T-135,T-136,T-137,T-138,T-139/ VASINDO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

15. Kode Contoh : 015/094BAPC/09/2019

Sample Code
Standar Produk : SNI IEC 60598.1:2016 & SNI 04-6973.2.1:2005
Standard of Product
Produk : LUMINAIRES
Product
Jenis Produk : Fixed General Purpose Luminaires
Type of Product
Spesifikasi; Model; Merek : Maks. 120 W/ 220-240 V/50-60 Hz / VK-2083 /
Specification; Model; Brand VASINDO
No. Batch/ Tanggal Produksi : September 22, 2019
Batch. No/ Production Date
Jumlah Contoh Produk yang Diambil : 6 pcs
Number of Product Sampled
Jumlah Total Populasi Produk : 6 pcs
Total Number of Product Population
Jumlah Contoh Uji : 3 pcs (for Laboratory)
Number of Test Sample
Jumlah Arsip Contoh : 3 pcs
Number of Sample Spare
Arsip Contoh Disimpan di : Pabrik
Sample Spare is kept in
Mewakili : Maks. 60 W/ 220-240 V/50-60 Hz / VSP-1622,
Spesifikasi; Model; Merek VSP-1660,VSP-1679,VSP-1718,VSP-1808,VSP-
Representative for specification, model, brand 1873 ,VSP-1878,VSP-1888,VSP-1913,VSP-C009,
VSP-2067,VSP-7779,VSP-1008,VSP-8401,VSP-
8402, VSP-8403,VSP-8404,VSP-8405,VSP-8406,
VSP-8407, VSP-8408,VSP-8409,VSP-2148,VSP-
2158,VSP-2175,VSP-2214,VSP-2710,VSP-2712,
VSP-2713,VSP-273, VSP-28028,VSP-2858,VSP-
2881,VSP-2882,VSP-293,VSP-3002,VSP-3003,
VSP-3004,VSP-326,VSP-3397,VSP-3894,VSP-
3918, VSP-3971,VSP-3972,VSP-4103,VSP-4133,
VSP-4113, VSP-4758,VSP-4759,VSP-4828,VSP-
4227,VSP-4260,VSP-4354,VSP-357,VSP-359,
VSP-5032,VSP-5035,VSP-508,VSP-5088,VSP-
5149, VSP-5283,VSP-5518,VSP-556,VSP-5869,
VSP-601,VSP-602,VSP-6026,VSP-6220,VSP-
6221, VSP-6878,VSP-773,VSP-737,VSP-733,VSP-

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

731,VSP-708,VSP-7560,VSP-7561,VSP-760,VSP-
79007,VSP-79009,VSP-8001, VSP-8004,VSP-
8014,VSP-80077,VSP-80080,VSP-80081, VSP-
8010,VSP-8553,VSP-8405,VSP-88016,VSP-
88030, VSP-88098,VSP-91009,VSP-9100,VSP-
91002, VSP-91003,VSP-96010,VSP-96011,VSP-
96012,VSP-96013,VSP-9363,VSP-9663,VSP-
9917, VSP-10881 ,VSP-10882,VSP-10883,TG-
1012,TG-2102,TG-2103,TG-2108,TG-2109,TG-
2110,TG-2117, TG-2175,TG-2183,TG-2193,TG-
901,TG-903,BL-105,BL-108,BL-032,BL-014,BL-
034,BL-022, BL-070,BL-071,BL-072,BL-051,BL-
052,BL-053,BL-054,BL-055,BL-056,BL-057,BL-
058,BL-059,BL-060, BL-6021,BL-6035, BL-
6037,BL-6039,BL-6012, H5058,H5066,H5067,
H5836, H5870, H5880, H6083, H6639,H6701,
M2006,M2010,M2018,M3001,M3002, M8004,
M8005,M9001,M9002, M9003, M9004,M9005,
M9006,MD-3015,MS-1008, SJ-4004,SJ-4006,SJ-
4008,SJ-4010,TY-1003,TY-1007,TY-2003, TY-
2012, VKY-6618,VKY-6620,VKY-6623,VKY-6625
VKY-6691, VKY-8925,VKY-8931,VKY-8990, VKY-
9031, VKY-9300,VKY-9301,VKY-9302, VKY-9303
VKY-9946, VKY-9982,VKY-9988, VKY-9990,VKY-
C910,VSK-7709, VSK-7719, VSK-7921,VSK-7488,
VSK-7523,VSK-7558, VSK-7562,VSK-7712,VSK-
7720,VSK-7740, VSK-7745,VSK-7867,VSK-7868,
VSK-7869, VSK-7936,VSK-7942,VSK-7943,VSK-
7981, VSK-7982,VSK-7983,VSK-8010,VSK-8253,
VSK-8256,VSM-8010,VSM-8143,VSA-8276,VSA-
8316,VSA-8446,VSA-8358,VSA-8418,VSA-8557,
VSA-8610,VSA-8698,VSA-8700,VSA-8708,VSA-
8722, VSA-8723,VSA-8725,VSA-8729,VSA-8832,
VSA-8886,VSA-8950,VSA-8923,VSA-8965,VSA-
8957,VSA-8923,VSP-3801,VSP-3803,VSP-1805,
VSP-8116,VSP-8120,VSP-8171,VSP-8216, VSP-
8277,VSP-90489, VSP-1708,VSP-1724,D6062,
D6063, D6065, D6076,VT-188, V-140149,V-
14070,VH-10118,VH-3185,VK-2083,VK-9207,
VK-2088,VK-5163,VK-2068,VK-3038,VK-3125,
VK-3191,VK-3229,VK-3060,VK-3109,VK-3230,

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

VK-3240,VK-8145,VK-8237,VK-8270,VK-8271,
VK-8292,VK-9011,VK-9028,VK-9002,VK-9055,
VK-9068,VK-9090,VK-9092,VK-9105,VK-9056,
VK-9057,VK-9058,VK-9059,VSR-1015,VSR-1033,
VSR-6020, VSR-A005,VSR-A006, VSR-1111,VSR-
9908,VSR-9907,VSR-9906,VSR-9905,VSR-9904,
VSR-9699, VC-100,VC-0049,VC-6852,VC-6859,
VC-6860,VC-6887,VC-6931,VC-6942,VC-2075,
VC-7743,VC-7805,VC-506,VC-5806,VC-5907,VC-
6004,VC-6057,VC-6062,VC-6065,VC-6066,VC-
6067,VC-6090,VC-9007,VC-9075,VC-9102,VC-
9470,VC-9108,VC-9112,VC-86287,VC-86294,VC-
86323, VC-86355,VC-86374, VC-86383,VC-
86434,VC-86520, VC-86557,VC-8538,VC-6807,
VC-8668,VC-8801,VC-8816, VC-8820,VC-8865,
VC-8868,VC-8869,VC-8872,VC-8879,VC-13246,
VC-1535,VC-1598,VC-1603,VC-6502,VC-6546,
VC-6548,VC-8503,VC-888,VC-7761,VC-7811,VC-
7812,VC-7813,VC-7814,VC-7815,VC-7816,VC-
7121,VC-7122,VC-7123,VC-7124,VC-H8069,VC-
9811,VC-9857,VC-9864,VC-9919,VC-10090,VC-
10084,VC-9871,VC-9872,VC-9873,VC-9874,VC-
9875,VC-9876,VC-9877,VC-9878,VC-9879,VC-
9880,A01,A02,A03, A05, A06, A07,A08,A09,A10,
A11, A12,A13,VSD-6610,VSD-6611,VSD-6612,
VSD-6613,VSD-6614,VSD-6616, VSD-6620,VSD-
6663, VSD-6667,VSD-6669,VSC-6025,VSC-8135,
VSC-8151,LA-3021,LA-3040,LA-3053,LA-3055,
LA-3056,LA-3058,LA-3059,,LA-3060,LA-6018,
LA-6025,LA-6060,LA-6062,LA-6070,LAG-1098,
LAG-1127,LAG-1236,LAG-1238, LAG-1257,LAG-
1301, LAG-1565,LAG-1906, LAG-2037,LAG-
2867, LAG-2910, LAG-2985,LAG-3062, LAG-
9850, LAG-9852,VSP-7513,VSP-7531,VSP-7571,
VSP-7572, VSP-7582,VSP-83002,VSP-83006,
VSP-85003, VSP-85005,VSP-8505,VSP-851,VSP-
C06,VSP-C71,VSP-C84,VSP-C1201, H6902,
H6903, H7032, H6905,H7090,H7089, H7092,
H7250 H7278, H7288,MD 8017,SD-1030 SD-
1082,VSP-18069, VSP-18070,VSP-18071,VSP-
18072, VSP-18073, VSP-18074,VSP-18075,VSP-

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

18076,VSP-18077, VSP-18078,VSP-76099,VSP-
76059, VSP-68070, VSP-85010,VSP-85053,VSP-
18012,VSP-18038, VSP-8958,VSG-2610,VSG-
611, VSG-6130,VSG-6812,VSG-8672,VSG-8625,
VSG-8620,VSG-8601, VSG-8945,VSG-8298,VSG-
8299, VSG-9995,VSG-9996, VSP-90164,VSP-
90523, VSP-90541,VSP-90544 / VASINDO

Gambar Contoh Uji, komponen utama :

Picture of sample, main parts

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 KEMENTERIAN PERDAGANGAN
BALAI SERTIFIKASI
LEMBAGA SERTIFIKASI PRODUK PPMB

Berita Acara Pengambilan Contoh Produk

Sampling Report

Samples are packed and identified with Sample
Label. Test Samples are delivered to Product
Certification Body PPMB maximum within 3
(three) months. Sample Spares have the same
Sample Code with Test Samples and are kept
by the Company.
Kemudian contoh tersebut dikemas dan diberi
identifikasi berupa Label Contoh. Contoh Uji
diserahkan kepada Balai Sertifikasi selambat-
lambatnya dalam jangka waktu 3 (tiga) bulan.
Arsip Contoh memiliki Kode Contoh yang sama
dengan Contoh Uji dan disimpan di perusahaan.

Saksi dari Perusahaan Petugas Pengambil Contoh

Witness from Company Sampling Officer

Nama: XU BANG WAN Nama: Ahmad Fasya

Name Name

Ketua Tim Evaluasi

Nama:
Tanda Tangan:

Untuk diperiksa oleh Balai Sertifikasi

Pemeriksa:

Tanggal:

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