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PT.

HITSS Sumber Daya Nusantara Konsultan


Name
NIP
Position
Company
Month

:
:
:
:
:

Andri Wijaya
61138
Field Engineer

PT. Wincor Nixdorf Indonesia


April-12

FORM PENGGANTIAN BIAYA TAXI


TANGGAL

1-Apr-12
2-Apr-12
3-Apr-12
4-Apr-12
5-Apr-12
6-Apr-12
7-Apr-12
8-Apr-12
9-Apr-12
10-Apr-12
11-Apr-12
12-Apr-12
13-Apr-12
14-Apr-12
15-Apr-12
16-Apr-12
17-Apr-12
18-Apr-12
19-Apr-12
20-Apr-12
21-Apr-12
22-Apr-12
23-Apr-12
24-Apr-12
25-Apr-12
26-Apr-12
27-Apr-12
28-Apr-12
29-Apr-12
30-Apr-12
1-May-12

KETERANGAN

Taxy Day

@ Rp. 35.000,-

Rp

@ Rp. 60.000,-

35,000.00
-

35,000

Taxy Holiday

JUMLAH

Rp

60,000

60,000.00
-

Taxy day

Taxy Day

Rp

35,000

Rp

35,000

Rp

105,000

35,000.00
-

Rp

Employee,

Approved By,

(Andri Wijaya )

( Muhammad Irian )

60,000

165,000.00

PT. HITSS Sumber Daya Nusantara Konsultan


Name
NIP
Position
Company
Month

:
:
:
:
:

Johan Aries Wahyudhy


61103
Field Engineer

PT. Wincor Nixdorf Indonesia


February-12

FORM PENGGANTIAN BIAYA TAXI


TANGGAL

KETERANGAN

@ Rp. 35.000,-

@ Rp. 60.000,-

JUMLAH

1-Feb-12
2-Feb-12
3-Feb-12
4-Feb-12
5-Feb-12
6-Feb-12
7-Feb-12
8-Feb-12
9-Feb-12
10-Feb-12
11-Feb-12
12-Feb-12
13-Feb-12
14-Feb-12
15-Feb-12
16-Feb-12
17-Feb-12
18-Feb-12
19-Feb-12
20-Feb-12
21-Feb-12
22-Feb-12
23-Feb-12
24-Feb-12
25-Feb-12
26-Feb-12
27-Feb-12
28-Feb-12
29-Feb-12

Rp

Rp

Employee,

Approved By,

( Johan Aries Wahyudhy )

( Muhammad Irian )

Rp

PT. HITSS Sumber Daya Nusantara Konsultan


Name
NIP
Position
Company
Month

:
:
:
:
:

Johan Aries Wahyudhy


61103
Field Engineer

PT. Wincor Nixdorf Indonesia


January-12

MEDICAL CLAIMS
TANGGAL

1-Jan-12
2-Jan-12
3-Jan-12
4-Jan-12
5-Jan-12
6-Jan-12
7-Jan-12
8-Jan-12
9-Jan-12
10-Jan-12
11-Jan-12
12-Jan-12
13-Jan-12
14-Jan-12
15-Jan-12
16-Jan-12
17-Jan-12
18-Jan-12
19-Jan-12
20-Jan-12
21-Jan-12
22-Jan-12
23-Jan-12
24-Jan-12
25-Jan-12
26-Jan-12
27-Jan-12
28-Jan-12
29-Jan-12
30-Jan-12
31-Jan-12

KETERANGAN

Obat-obatan
Kacamata

Nominal
Kwitansi

Rp
Rp

43,500
300,000

Rp

343,500

Penggantian
100%

JUMLAH

43,500.00
300,000.00
Rp

Rp

343,500

Note :
A = Doctor
B = Medicine
C = Dentist
Jakarta, 10 Mey 2011
Employee,

( Johan Aries Wahyudhy )

D = Glasses
E = Hospitalization
F = Laboratorium

* Kacamata Max Rp. 300.000,-

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