FORM KA 1/1

(Rev. 2007)

Your Ref.

Our Ref.

Syarikat Bekalan Air Selangor Sdn. Bhd

(SYABAS)

Melalui,

Ketua Wilayah

(Pengurus Besar/Penolong Pengurus Besar/Pengurus Kanan)

SYABAS Wilayah

PART A

Handing Over of Water Reticulation System

On Lot No : .

..

..

I/We, the undersigned being the developer / proprietor of the abovementioned development hereby agree :-

i. To surrender without any conditions to Syarikat Bekalan Air Selangor Sdn. Bhd (SYABAS) all

rights to all pipelines and waterworks fittings within the development, after which these water

supply installations shall be the properties of the State Government of Selangor or Federal

Government (as case may be) to be operated and maintained at SYABASs expenses unless

otherwise provided for in the Water Supply (Selangor) Rules and Enactment 1997 and any

other rules made hereunder.

ii. That SYABAS shall be relieved of all financial responsibility in respect of liabilities incurred in

the execution of water supply system by developer.

iii. We, confirm that there is no financial encumbrances on SYABAS in respect of pipelines and

ancillary works surrendered hereby to SYABAS.

. ..

Name + Signature of Consultant Name + Signature of Developer / Proprietor

Date . Date

SYARIKAT BEKALAN AIR SELANGOR SDN BHD

PART B FORM KA 1/1

(Rev. 2007)

(To be completed by Consulting Engineers/Developer)

Handing over of Water Reticulation System.

On Lot .

.

1. Pipeline :

Nominal Diameter

(mm)

Material Type Class/Rating Name of Approved

brand

Length

(m)

2. Sluice Valve 3. Air Valves

4. Fire Hydrants: 5. Scour Valves:

Size

(mm)

Name of

Approved brand

Nos.

SYARIKAT BEKALAN AIR SELANGOR SDN BHD

Size

(mm)

Name of

Approved brand

Nos.

Size

(mm)

Name of

Approved brand

Nos.

Size

(mm)

Name of

Approved brand

Nos.

FORM KA 1/1

(Rev. 2007)

6. Butterfly Valves 7. Zone Meters

Size

(mm)

Name of

Approved brand

Nos.

8. Water Sampling Points 9. Others :.

(Specify details)

10. Construction Costs

i. Pipes and joints supply RM

ii. Specials and valves supply RM

iii. Labour for lay and fix RM

.

iv. Others RM

.

Size

(mm)

Name of

Approved brand

Nos.

SYARIKAT BEKALAN AIR SELANGOR SDN BHD

Size

(mm)

Nos.

Location

Nos.

FORM KA 1/1

(Rev. 2007)

11. We enclosed herewith the following :-

i. Copies of Invoices of pipes, joints and fittings, value of tender/ Quotation works.

12. These pipelines cover the following requirement :-

No of Units

i. Low Cost

ii. Terrace House

iii. Bungalow Semi Detached

iv. Shop House

13. a. We hereby certify that the above installation have been supervised by us and laid in

accordance with the plans and specifications approved by SYABAS vide letter reference no.

. Dated

b. We hereby undertake full responsibility for the design and construction of water reticulation

works, any non-compliance and deviations of the said external water supply works.

Agreed by Developer, Certified by Consultant,

. ..

Signature Signature

Name : Name :

Stamp of developer : Stamp of Consultant : .

Date : .. Date : .

SYARIKAT BEKALAN AIR SELANGOR SDN BHD

v. Others 11 Units .... (Shop Office)

PART C (For Office Use) FORM KA 1/1

(Rev. 2007)

Handing over of Water supply Reticulation

On Lot

.

1. As Built Plans Ref : No

2. Checking and approval of As-built plans.

Checked by Technician Reviewed by Head of Development

section/ Technical Manager :

Signature Signature

Name : Name : .

Date : Date : .

3. Updating of plans by Mapping unit.

Updated by Head of Mapping unit:-

.

Signature

Name :

Designation :

Date :

4. Approved by Ketua Wilayah,

.

Signature

Name :.

Date :.

SYARIKAT BEKALAN AIR SELANGOR SDN BHD