PT.

MARITIM SURVEINDO INTERNUSA (MSI)

Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : BG. HARSINDO 02

Location : AMM Dockyard, Samarinda
Kind of Job : Damage Survey
Order From : PT MCO Prima Indonesia/ PT Asuransi Jasa Indonesia
Surveyor Name : Vincencius Simamora
Date of Survey : 08.06.18 - 10.06.18

No Date Description Amount

1 Travel Dari Depok ke Bandara Halim Rp 109,000
2 Travel Dari Bandara Balikpapan ke Samarinda Rp 150,000
8 Juni 2018
Travel Dari Samarinda Ke Pelabuhan dan ke
3 By Owner
Hotel
4 Hotel Rp 270,000
9 Juni 2018 Hotel Rp 231,000
8 Travel dari Hotel ke Bandara Balikpapan Rp 200,000
10 Juni 2018
Travel dari Soeta ke Depok Rp 200,000
13 Meals 3 days Rp 300,000
Total Expenses Rp 1,460,000
Cash Advance Rp 3,000,000
Amount Due company/employee Rp 1,540,000

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : AHTSV "JOJO BRIGHTLINKS"

Location : CNOOC AREA, LAUT JAWA
Kind of Job : Damage Survey
Order From : PT Asuransi FPG Indonesia
Surveyor Name : Vincencius Simamora
Date of Survey : 15.06.18 - 18.06.18

No Date Description Amount

Buat Surat Sehat buat permit masuk ke CNOOC
1 Rp 70,000
Area
13 Juni 2018
Travel dari Depok ke Kantor CNOOC (Sudirman)
2 Rp 21,000
buat urus permit

3 Travel dari Depok ke Pelabuhan Kalijapat CNOOC Rp 187,000

15 Juni 2018
4 Meals Rp 100,000
5 16 Juni 2018 Meals Rp 100,000
6 17 Juni 2018 Meals Rp 100,000
Meals Rp 100,000
7 18 Juni 2018
Travel dari Pelabuhan Kalijapat ke Depok Rp 187,000

Total Expenses Rp 865,000

Cash Advance Rp 500,000
Amount Due company/employee Rp (365,000)

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Syaiful Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : TB LOSARI - OB RATU SAPHIRE & BG INDOMARINA 3001

Location : Balikpapan & Samarinda
Kind of Job : Damage Survey
Order From : PT Asuransi Multi Artha Guna
Surveyor Name : Vincencius Simamora
Date of Survey : 29.06.18 - 01.07.18

No Date Description Amount

1 Taxi Dari Cawang ke Bandara Soeta Rp 174,000
Taxi Dari Bandara Balikpapan ke Pelabuhan
2 Rp 74,000
Semayang
3 29 Juni 2018 Boat ke kapal by owner
4 Taxi dari Pelabuhan Semayang ke Halte Bus Rp 74,000
5 Bus Balikpapan - Samarinda Rp 150,000
6 Hotel Rp 239,000
7 Taxi dari Hotel ke Galangan KM Rp 131,000
8 Taxi dari Galangan KM ke kantor Barokah Rp 200,000
9 Travel dari kantor Barokah ke Pulau atas by owner
10 30 Juni 2018 Travel dari Pulau Atas ke Halte Bus by owner
11 Taxi dari Samarinda ke Balikpapan Rp 150,000
Gojek dari Halte Bus ke Hotel Rp 15,000
12 Hotel Rp 299,000
13 1 Juli 2018 Taxi dari Bandara Soeta ke Cawang Rp 174,000

14 Meals 3 days Rp 300,000

Total Expenses Rp 1,980,000

Cash Advance Rp 1,500,000
Amount Due company/employee Rp (480,000)

Prepared by : Approved by :
Surveyor Director Finance
Date : …………….. Date : Date :
Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : TB NIAGA Mas 1 - BG BAL 3888

Location : Banjarmasin
Kind of Job : Damage Survey
Order From : PT Asuransi Asoka Mas
Surveyor Name : Vincencius Simamora
Date of Survey : 04.07.18 - 05.07.18

No Date Description Amount

1 Travel Dari Cawang ke Soeta Rp 147,000
Travel Dari Bandara Banjarbaru ke Sungai
2 Rp 200,000
Danau
3 4 Juli 2018 Travel dari sungai danau ke pelabuhan boat By Owner
4 Boat By Owner
5 Travel dari Pelabuhan boat ke hotel By Owner
6 Hotel Rp 230,000
Travel dari Sungai Danau ke Bandara
7 Rp 200,000
Banjarbaru
5 Juli 2018
8 Taxi dari bandara soeta ke cawang Rp 147,000

Meals 2 days Rp 300,000

Total Expenses Rp 1,224,000
Cash Advance Rp 1,500,000
Amount Due company/employee Rp 276,000

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : RMN 308, RMN 342J, RMN 354

Location : Samarinda
Kind of Job : Damage Survey
Order From : PT Asuransi Multi Artha Guna
Surveyor Name : Vincencius Simamora
Date of Survey : 09.07.18 - 11.07.18

No Date Description Amount

1 09 Juli 2018 Ojek Dari Cawang ke Bandara Halim Rp 15,000

2 Travel Dari Bandara Balikpapan ke Samarinda Rp 200,000

10 Juli 2018
3 Travel Dari Hotel Ke Galangan dan ke Hotel By Owner
4 Hotel Rp 260,000
Hotel Rp 260,000
8 Ojek dari Hotel ke Kantor KSA Rp 20,000
11 Juli 2018 Taxi dari kantor KSA ke Halte Bus Rp 64,000
Bus Samarinda ke Balikpapan Rp 150,000
Taxi dari Soeta ke Cawang Rp 161,000
13 Meals 3 days Rp 300,000
Total Expenses Rp 1,430,000
Cash Advance Rp 1,500,000
Amount Due company/employee Rp 70,000

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny
Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : MV OSTINA

Location : Tg. Priok, Jakarta
Kind of Job : Damage Survey
Order From : PT Asuransi Asoka Mas
Surveyor Name : Vincencius Simamora
Date of Survey : 14.07.18

No Date Description Amount

1 Taxi Dari Cawang ke IPC Rukindo Shipyard Rp 107,000

2 Taxi Dari IP Rukindo Shipyard ke Cawang Rp 107,000

14 Juli 2018
3 Meals Rp 100,000

Total Expenses Rp 314,000

Cash Advance Rp -
Amount Due company/employee Rp (314,000)

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : MV OSTINA

Location : Tg. Priok, Jakarta
Kind of Job : Damage Survey (Lanjutan)
Order From : PT Asuransi Asoka Mas
Surveyor Name : Vincencius Simamora
Date of Survey : 19.07.18

No Date Description Amount

1 Taxi Dari Cawang ke IPC Rukindo Shipyard Rp 95,000

2 Taxi Dari IP Rukindo Shipyard ke Cawang Rp 95,000

19 Juli 2018
3 Meals Rp 100,000

Total Expenses Rp 290,000

Cash Advance Rp -
Amount Due company/employee Rp (290,000)

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : TB NIAGA Mas 1 - BG BAL 3888

Location : Banjarmasin
Kind of Job : Damage Survey (lanjutan)
Order From : PT Asuransi Asoka Mas
Surveyor Name : Vincencius Simamora
Date of Survey : 20.07.18

No Date Description Amount

1 Travel Dari Cawang ke Soeta Rp 140,000
Travel Dari Bandara Banjarbaru ke Pelabuhan Rp
2 128,000
Speed
20 Juli 2018 Boat
3 By Owner
4 Travel dari Pelabuhan boat ke Bandara Rp 128,000
5 Taxi dari bandara soeta ke cawang Rp 140,000
Pulsa Rp 50,000
Meals 1 days Rp 100,000
Total Expenses Rp 686,000
Cash Advance Rp 1,500,000
Amount Due company/employee Rp 814,000

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : MV. BELINI IX

Location : Tanjung Priok, Jakarta Utara
Kind of Job : Damage Survey (lanjutan)
Order From : PT Asuransi Asoka Mas
Surveyor Name : Vincencius Simamora
Date of Survey : 23.07.18

No Date Description Amount

1 Taxi Dari Cawang ke Tg. Priok By Pak Ibnu
2 Boat By Owner
23 Juli 2018
3 Taxi Tg. Priok ke Tamini Square Rp 94,000
4 Meals 1 days Rp 100,000
Total Expenses Rp 194,000
Cash Advance Rp 300,000
Amount Due company/employee Rp 106,000

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : HB. SM 121

Location : Samarinda
Kind of Job : Damage Survey (lanjutan)
Order From : PT Asuransi Jasa Indonesia
Surveyor Name : Vincencius Simamora
Date of Survey : 26.07.18 - 29.07.18

No Date Description Amount

1 Taxi Dari Cawang ke Bandara Soeta Rp 140,000

2 Bus dari Balikpapan ke Samarinda Rp 150,000
26 Juli 2018
3 Ojek dari Halte Bus ke Hotel Rp 15,000
4 Hotel Rp 255,000
5 Ojek dari Hotel ke Kantor Jasindo Samarinda Rp 15,000
6 27 Juli 2018 Travel dari kantor Jasindo ke kantor ASL By Jasindo
7 Hotel Rp 230,000
8 Boat ke laut By MCO
9 Pelabuhan Speed ke Halte Bus Rp 20,000
28 Juli 2018
10 Bus dari Samarinda ke Balikpapan Rp 150,000
11 Hotel Rp 250,000
12 Taxi dari Soeta ke Cawang Rp 140,000
29 Juli 2018
13 Meals 4 days Rp 400,000
Total Expenses Rp 1,765,000
Cash Advance Rp 1,500,000
Amount Due company/employee Rp (265,000)

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny
Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : TB. Samudra Tirta A

Location : Dumai
Kind of Job : Damage Survey
Order From : PT Asuransi Adira Dinamika
Surveyor Name : Vincencius Simamora
Date of Survey : 05.08.18 - 07.08.18

No Date Description Amount

1 Taxi Dari Cawang ke Bandara Soeta Rp 140,000

2 05 Agust 2018 Bus dari Pekanbaru ke Dumai Rp 150,000
3 Hotel Rp 298,338
5 Travel dari hotel ke Pelabuhan By Owner
6 Boat ke kapal By Owner
06 Agust 2018
Travel dari Dumai ke Pekanbaru Rp 150,000
7 Hotel Rp 287,743
8 Ojek dari hotel ke Bandara Rp 15,000
07 Agust 2018
12 Taxi dari Soeta ke Cawang Rp 140,000
13 Meals 3 days Rp 300,000
Total Expenses Rp 1,481,081
Cash Advance Rp 1,500,000
Amount Due company/employee Rp 18,919

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : MV. Soemantri Brodjonegoro

Location : Belawan, Sumatera Utara
Kind of Job : Damage Survey
Order From : PT Asuransi JASINDO / PT MCO
Surveyor Name : Vincencius Simamora
Date of Survey : 11.08.18 - 15.08.18

No Date Description Amount

1 Taxi Dari Cawang ke Bandara Soeta Rp 143,000

Sabtu, 11 Agust Bus dari Bandara ke Hotel
2 Rp 200,000
2018
3 Hotel Rp 307,000
Minggu, 12
4 Hotel Rp 307,000
Agust 2018
Senin, 13 Agust Hotel
5 Rp 307,000
2018
6 Taxi dari Hotel ke Pelabuhan Belawan Rp 102,000
7 Selasa, 14 Boat ke kapal Rp 1,000,000
8 Agust 2018 Taxi dari belawan ke hotel (bandara) Rp 174,000
9 Hotel Rp 237,000

10 Rabu,2018
15 Agust Taxi dari Bandara Soeta ke Cawang Rp 143,000

Meals 5 days Rp 500,000

Total Expenses Rp 3,420,000
Cash Advance Rp 3,000,000
Amount Due company/employee Rp (420,000)

Prepared by : Approved by :
Surveyor Director Finance

Date : …………….. Date : Date :

Name : Vincent Name : Ibnu Wibowo Name : Renny
Payment Made to :
Name
A/C No.
Bank
 PT. MARITIM SURVEINDO INTERNUSA (MSI)
Independent Surveyor & Consultant

EXPENSES REPORT

Name of Vessel : BG. MITRA 3002

Location : Siak River, Pekanbaru, Riau
Kind of Job : Damage Survey
Order From : PT. Asuransi Asoka Mas
Surveyor Name : Herlambang Lutvi Yudhian
Date of Survey : 21 February 2019

No Date Description Amount

Taxi From Pinang Ranti to Soekarno - Hatta Airport Rp
1 227,000
(Tol Include)
Trip From Sultan Syarif Kasim II Airport to Siak River
2 21 February 2019 Boat Rental By Owner
Trip From Siak River to Hotel
3 Hotel + Trip to Sultan Syarif Kasim II Airport Rp 384,000
4 Meals 1 days Rp 100,000

22 February 2019 Trip to Soekarno - Hatta Airport to Pinang Ranti

5 Rp 220,000
(Tol Include)
Total Expenses Rp 931,000
Cash Advance Rp 1,500,000
Amount Due company/employee Rp 569,000

Prepared by : Approved by :
Surveyor Director Finance

Date : 22 February 2019 Date : Date :

Name : Herlambang L Y Name : Ibnu Wibowo Name : Renny

Payment Made to :
Name
A/C No.
Bank