PAYMENT REQUEST FORM

(FORMULIR PERMINTAAN PEMBAYARAN)

PT IGP INTERNASIONAL BANTUL

For non-cash advance request
No. :

Requested by (Diminta oleh) : Ranti Buwana Asri

Department (Departemen) : Finance
Cost Center (Pusat Biaya) :
Requested Payment Date
:
(Permintaan Tanggal Pembayaran) 09.08.2019
Amount (Jumlah) : Rp. 3,082,250.00
Say (Terbilang) :

Purpose (Keperluan) : Biaya pengiriman matel dalam 8 hari

10, 11, 12, 15, 16, 18, 22, 25 Juli 2019

Beneficiary/Account Name
:
(Penerima/Nama Rekening) Anastasia. W
Account Number (Nomor Rekening) Bank & Branch (Bank & Cabang)
1 6 9 0 1 5 9 3 3 0

Actual Payment Date

:
(Tanggal Pembayaran Aktual)

Mode of Payment (Cara Pembayaran) : Cash (Tunai) Cheque (Cek)

Giro (Giro) TT (TT)

V Electronic Banking
Sender's Bank & Branch
:
(Bank Pengirim & Cabang) MANDIRI - 137 001587 0971
Currency of Bank (Mata Uang Bank) : IDR

Account Charging Description (Keterangan) Amount (Jumlah)

1. Rp. 3,082,250.00
2.
3.
4.
5.
6.
Total (Jumlah) Rp. 3,082,250.00

Head Office Finance Approval Bantul Office Finance Approval Requested by,
Plant Head Approval
(Disetujui oleh Keuangan Pusat) (Disetujui oleh Keuangan Cabang) (Diminta oleh)

Name:
(Nama):
Oskar Mulia Ranti Buwana Asri
Position:
(Jabatan): Director Snr. Manager Finance Regional head verificator Plant Manager Finance
Original (Lembar I): Finance (Keuangan), Copy (Lembar II): Budget PIC FIN/Rev.2/02/14
EQUEST FORM
NTAAN PEMBAYARAN)

For non-cash advance request

Filled by Department
Filled by Finance

Requested by,
(Diminta oleh)

Ranti Buwana Asri

Finance
FIN/Rev.2/02/14
 PAYMENT REQUEST FORM
(FORMULIR PERMINTAAN PEMBAYARAN)

PT IGP INTERNASIONAL BANTUL

For non-cash advance request
No. :

Requested by (Diminta oleh) : Ranti Buwana Asri

Department (Departemen) : Finance
Cost Center (Pusat Biaya) :
Requested Payment Date
:
(Permintaan Tanggal Pembayaran) 10.08.2019
Amount (Jumlah) : Rp. 346,000.00
Say (Terbilang) :

Purpose (Keperluan) : PAJAK SCRAP PER JULI 2019

Beneficiary/Account Name
:
(Penerima/Nama Rekening) Anastasia. W
Account Number (Nomor Rekening) Bank & Branch (Bank & Cabang)
1 6 9 0 1 5 9 3 3 0

Actual Payment Date

:
(Tanggal Pembayaran Aktual)

Mode of Payment (Cara Pembayaran) : Cash (Tunai) Cheque (Cek)

Giro (Giro) TT (TT)

V Electronic Banking
Sender's Bank & Branch
:
(Bank Pengirim & Cabang) MANDIRI - 137 001587 0971
Currency of Bank (Mata Uang Bank) : IDR

Account Charging Description (Keterangan) Amount (Jumlah)

1. Rp. 346,000.00
2.
3.
4.
5.
6.
Total (Jumlah) Rp. 346,000.00

Head Office Finance Approval Bantul Office Finance Approval Requested by,
Plant Head Approval
(Disetujui oleh Keuangan Pusat) (Disetujui oleh Keuangan Cabang) (Diminta oleh)

Name:
(Nama):
Oskar Mulia Ranti Buwana Asri
Position:
(Jabatan): Director Snr. Manager Finance Regional head verificator Plant Manager Finance
Original (Lembar I): Finance (Keuangan), Copy (Lembar II): Budget PIC FIN/Rev.2/02/14
EQUEST FORM
NTAAN PEMBAYARAN)

For non-cash advance request

Filled by Department
Filled by Finance

Requested by,
(Diminta oleh)

Ranti Buwana Asri

Finance
FIN/Rev.2/02/14