This document is a form for calculating the domestic content percentage of an offer or bid. It contains tables to list items or services provided, their individual values, the domestic content percentage and value. The total domestic content percentage is calculated by taking the total domestic content value and dividing it by the total quoted price. Notes provide definitions for personnel, equipment, construction services, and materials. The bidder must sign and include a duty stamp on the completed form.

1. FORMULIR PERHITUNGAN TINGKAT KOMPONEN DALAM NEGERI
DOMESTIC CONTENT CALCULATION FORM
FORMULIR No. : SC-02
Nama Peserta/Bidder Name :
Total Nilai Penawaran/ Total Quoted Price:
Deskripsi/Description
% Komponen Dalam Komponen Dalam
Butir/Item Negeri (KDN)/ Negeri Penawaran/
Domestic Content (DC) Quoted Domestic
Content
Nilai per Item
Nilai/Value %
/Item Value %
a b c d=axc e
A. BARANG/GOODS
I. MATERIAL TERPAKAI
Used Materials
II. PERALATAN
Equipment
Sub Total (A)
B. JASA/SERVICES
III. PERSONIL/KONSULTAN
Personnel/Consultant
IV. ALAT KERJA/PERALATAN
Tools/Equipment
V. KONSTRUKSI/FABRIKASI
Construction/Fabrication
VI. JASA UMUM DLL.
Other Services
Sub Total (B)
C. JUMLAH (T O T A L)=
Sub Jumlah A+ B
b : Nilai per Item/Jumlah Nilai Penawaran x 100%
e : Nilai KDN Penawaran/Jumlah Nilai Penawaran x 100%
Catatan/Note:
Personil/Konsultan : Rekayasa, survey perencanaan, pengawasan, manajemen, tenaga kerja, dll.
Personnel/Consultant Engineering, research design, supervision, management, personnel etc.
Alat Kerja/Peralatan : Sewa rig, sewa kendaraan, sewa kapal, sewa pompa, dll.
Tools/Equipment Rental of rig, vehicle, barge, pump, etc.
Konstruksi/Fabrikasi : Konstruksi sipil, mesin, listrik, dll.
Construction/Fabrication Civil, mechanical, electrical construction, etc.
Jasa Umum dll. : Pengurusan, asuransi, sewa rumah, dll.
Other Services etc. Management handling, insurance, house rent, etc.
Material Terpakai : Pipa, Semen, Chemical, dll.
Material Used Pipe, Cement, Chemical, etc
Peralatan : Pompa Kompresor, Generator dll
Equipment Pump, Compressor, Generator, etc
Tanda Tangan :
Signature
Materai :
Duty Stamp
Nama & Jabatan Penandatangan : _____________________________