PT.

BIROTIKA SEMESTA
Building F, Siemens Business Park
Jl. M.T. Haryono Kav 58-60
Jakarta 12780, Indonesia
Toll Free: 0-800-1333-333
NPWP 01.310.774.3.061.000 - Date: 12-08-2003

*3102506536*
INBOUND CHARGES INVOICE

PT SARANABAJA PERKASA
JL.KOL.BEJO NO.48
PULO BRAYAN DARAT II
MEDAN TIMUR
20239
Attn: .
Contact Number:

Account Number
Invoice Number
HWB Number
Date
Payment Due Date

: DUTYIDCGK
: D03799996
: 3102506536
: 22/12/2015
: 22/12/2015

Please Reimburse the Total Charges Shown Below To: PT. BIROTIKA SEMESTA

Shipment Details
Origin:
KIX
Destination: CGK

Pieces: 1
Weight: 14.50

Contents: LIFTING TOOL

Assessed Value:

Arrival Date:

22/12/2015

Billing Details
DUTY & TAXES
BANK CHARGES
DOCUMENT CHARGE
DUTY HANDLING CHARGE
VAT FOR OTHER CHARGES

1,033,000
50,000
20,000
50,000
7,000

Payment Terms

Cash on delivery unless

stated otherwise on the invoice
THIS IS A COMPUTER GENERATED INVOICE. NO SIGNATURE IS REQUIRED.

Please Pay This Amount: IDR

1,160,000

Remittance Advice
Company Signature / Stamp:
We enclose cash for IDR 1,160,000
We enclose cheque No. ________________ for IDR 1,160,000
Please debit our Credit / Charge Card No. ____________________________
Cardholder name: _______________________________

Account Number

: DUTYIDCGK

Invoice Number

: D03799996

HWB Number

: 3102506536

Date

: 22/12/2015

Total Amount IDR

: 1,160,000

Expiry date: ____________________________________

Not all payment options are available to all countries

* D U T Y

D C G K *

* D 0 3 7 9 9 9 9 6

1. Detach this payment advice and return it together with your payment
2. Cheque should be crossed and made payable to PT. BIROTIKA SEMESTA

Customer Endorsement
SSPCP

PIB/PIBT

Nota 2A

We acknowledge receipt of the above documentation

Account Number

: DUTYIDCGK

PT SARANABAJA PERKASA

Invoice Number

: D03799996

Company Signature / Stamp:

HWB Number

: 3102506536

Printed Name / Title:

Date

: 22/12/2015

Total Amount IDR

: 1,160,000

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