GREAT VISION SOLUTION SDN BHD (1203016-X)

No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB- UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 22mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

No indication was Accepted

1. Item : Column 12/Q detected during the inspection
time
Joint No. : JT 1 (Top & Bottom)

2. Item : Column 12/L

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 1 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB- UT-001-ESSB-0122 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 22mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column 12/K No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column 12/H

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 2 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB- UT-001-ESSB-0122 ULTRASONIC EXAMINATION Report No. : UT-015-GOW-0722 Rev.0
REPORT

Client : GENSON ORNAMENTAL WORKS Ultrasonic Equipment / : USM GO

Serial No. : GOPLS16030204
Project : PROJEK PEMBANGUNAN
KEBUK ELECTROMAGNETIC Cable Type/Length : Lemo to Lemo/2 meter
COMPATIBILITY
Client : GENSON ORNAMENTAL WORKS Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 22mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column 12/J No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column 12/E

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 3 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 22mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column 2/Q No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column 2/L

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 4 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 22mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column 2/K No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column 2/J

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 5 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 22mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item Column 2/H No indication was Accepted

detected during the inspection
Joint No. JT 1 (Top & Bottom) time

2. Item Column 2/E

Joint No. JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 6 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 20mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column E9 No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column E7

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 7 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 20mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column E5 No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column E4

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 8 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 20mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column Q4 No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column Q6

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 9 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

Our ref.: GVSSB-UT-015-GOW-0722 ULTRASONIC EXAMINATION Report No.: UT-015-GOW-0722 Rev.0
REPORT

Ultrasonic Equipment / : USM GO

Client : GENSON ORNAMENTAL WORKS Serial No. : GOPLS16030204

Project : PROJEK PEMBANGUNAN Cable Type/Length : Lemo to Lemo/2 meter

KEBUK ELECTROMAGNETIC
COMPATIBILITY Procedure No. : GVS/UTFD/001 Rev. 0

Material : Carbon Steel Couplant : Wallpaper Paste

Thickness : 20mm Calibration Block : V1, V2 & API Blocks

Welding Process : FCAW Examination Standard : BSEN IS0 23278: 2015

Weld. Preparation : Single V. Acceptance Standard : Table 6.2

Surface Condition : Cleaned Examination Date : 27th July 2022

Probe Parameter:
Serial No Beam Angle Frequency Size PRE-Level Tr. Loss Scanning Range
05797 0° 5 Mhz Ø10 mm 32 dB - 2nd BWE 100 mm
0969 45° 4 Mhz 8x9 mm 45 dB +2 dB +6 dB 100 mm
0757 60° 4 Mhz 8x9mm 49 dB +2 dB +6 dB 100 mm
0568 70° 4 Mhz 8x9mm 54 dB +2 dB +6 dB 100 mm

Sensitivity setting:
Angle probes: Set Reference Level at 80% FSH from 1.5 mm Ø reflector of API block 75 mm
Normal probe: Set 1st BWE at 100% FSH

No. Joint Reference Interpretation Result Remark

Ultrasonic testing was carried out on the item as

following details:

1. Item : Column Q7 No indication was Accepted

detected during the inspection
Joint No. : JT 1 (Top & Bottom) time

2. Item : Column Q8

Joint No. : JT 1 (Top & Bottom)

Inspected By : Reviewed By : Witnessed By :

Signature : Signature : Signature :
Name : Zaidi – NDT Level II Name : Name of Client’s Rep. :
Date : 28-07-2022 Date : Date :

Page 10 of 11
 GREAT VISION SOLUTION SDN BHD (1203016-X)
No.43-A, Jalan Rebana, Off Jalan Seruling 59, Taman Klang Jaya, Kawasan 3,
41200 Klang, Selangor Darul Ehsan, Malaysia.
Email: admin@grevis.com.my Tel: +6(03)33192999

ULTRASONIC EXAMINATION REPORT (UT)

GENERAL VIEW AND EQUIPMENT DETAIL

NDT Operator : Reviewed By : Approved By :

Signature : Signature : Signature :

Name : Zaidi – NDT Lev II Name : Name :
Date : 28/07/2022 Date : Date :

Page 11 of 11