FORM NO.

2 FRM/FIN-002
REV. NO. 002 PAGE 1 of 1

FORM ADVANCE SETTLEMENT ISSUED DATE Wednesday, April 15, 2015

NAME Ichank
: & Andhito Personal 2 ADVANCE DATE : 6 Nov 15
No. Adv. Stlmnt BJM.003 1 6-12 Nop 15
DEPARTMENT
( Jakarta ) SETTLEMENT DATE : 5 Nov 15 12 Nov 15 0
:
DESTINATION SUDAN 7 Hari Dinas Luar

SUPERVISION INFORMATION
LOCATION DESCRIPTION TOTAL ADVANCE ACTUAL COST DIFFERENCE
DATE AMOUNT UNIT
COST CENTER
Rp. Rp. Rp.
6-12 Nop 15 SUDAN Transport Bandara - Rumah ( langsam ) 150,000 2 BJM.003 300,000 - 300,000
6-12 Nop 15 SUDAN Meals ( langsam ) 180,000 7 BJM.003 1,260,000 - 1,260,000
6-12 Nop 15 SUDAN Hotel 350,000 6 BJM.003 2,100,000 - 2,100,000
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
6-12 Nop 15 SUDAN - - - BJM.003 - - -
-
3,660,000 - 3,660,000

UNDERPAID/ OVERPAID *) Rp. 3,660,000

CHECKED BY APPROVED BY
PREPARED / REQUESTED BY RECEIVED BY
FINANCE DIR GM DIRECTOR
NO APPRFL : NO APPRFL : NO APPRFL : BJM.003 NO APPRFL :

Ichank & Andhito #REF! M.SOFIYUDIN ICHANK Ichank & Andhito

DATE: 6 Nov 15 DATE: DATE: 6 Nov 15 DATE: DATE: DATE:

*) Please cross unused lines Note: Please attach supporting document

 FORM NO. 1 FRM/FIN-001
REV NO. 02 Page 1 of 1
FORM TEMPORARY CASH ADVANCE ISSUED NO. 15 APRIL 2015

DATE : 06-Nov-15
NAME : Ichank & Andhito NOTE : 10-15 Okt 15
Reff Adv. Stlmnt : BJM.003 No.Adv 1 10-Oct s/d 15-Oct
DEPARTMENT : ( Jakarta ) Periode : 5.00

BRANCH : SUDAN

AMOUNT REQUESTED : Rp 3,660,000

PERIOD : 5 hari

PURPOSE : TEMPORARY CASH ADVANCE 3,660,000

-
-
DATE PAID :\ -
Note : -
Ditranfer ke Name : Ichank & Andhito -
Bank : -
Nomor Rek : NOTE : .

CHECKED BY APPROVED BY
PREPARED / REQUESTED BY
GM BRANCH MNGR FNC DIR DIRECTOR
NO APPRFL : SUDAN NO APPRFL : NO APPRFL : NO APPRFL :

Ichank & Andhito ICHANK M.KHAIRUDIN M.SOFIYUDIN

00-Jan-00 00-Jan-00 DATE DATE: 0 DATE: