Consultant Invoice

Submitted To: Consultant Name: Munazar

FHI 360. Address:
Menara Salemba 3rd Floor, Jl. Salemba Raya No.5 Jl. Raya Kalibata, Jakarta Selatan, 12750, Jakarta- Indonesia
Jakarta Pusat 10440 Indonesia Phone : 0852 0690 3380 (Cell)
Other: E-mail : fhi360@munazar.com, munazarbunda@gmail.com
Please check one below:
CAROLINE FRANCIS __ __YES, I am subject to U.S. taxation. My Social Security
Attention: Number or Tax Identification Number has been provided to FHI
360.
Project No:
__X _NO, I am not subject to U.S. taxation.
LINKAGES Cons. Agreement Number:
Project Title:
PO Number:
Deliverables Original Source Code (Software Application Packaged) and Online Website Application System
Submitted:
Description of Detail Description of Work Performance on Appendix 1
Work Performed:
Date(s) of Service: QTY Unit of Qty. Unit Rate Amount
(Day(s) or Hour(s) ) Curr: IDR Curr: IDR
01 – 30 April 2020 15 120 hours 1,350,000 20,250,000

Add’l Quantity: 15 Add’l Amount: 20,250,000

(Carryover from Page 2) (Carryover frpg 2)
Total Quantity: 15 120 hours Total Amount: 20,250,000

200 hours
I hereby certify that this request for payment is an accurate statement of my hours/days worked on the above indicated
project, that this request does not violate any federal, state or local laws or regulations and is in accordance with the terms
and conditions of my Consulting agreement with FHI 360. I further certify that out of pocket expenses claimed, if any,
were necessary for performance of these services and were duly authorized and I havenot received compensation from any
other source for the same days/hours worked for FHI 360.

Consultant Name (Print): _Munazar_____________ Signature: _________________________________

Date: 24 April 2020

I hereby certify that I have reviewed this Consultant invoice and that is an accurate statement of the hours/days worked
and the performance/deliverables as stated above.

FHI 360 Project Monitor (Print): __________________ _____________ Signature: _________________________________

Date: ______________________________

FHI 360 Use Only:

Vendor Number: Date:
Project Allocation: Special Instructions:
Invoice Amount:
Outstanding Advance:
Net Pay: Prepared By:
Project No: _0936.0529, Consultant Name : Munazar

Project Title: _LINKAGES

Consultant Agreement No:

PO No: _

Dates or Service: QTY: Unit of QTY Unit Rate Amount

(Days or hours):
1-Apr-20 1 8 hours 1,350,000 1,350,000
2-Apr -20 1 8 hours 1,350,000 1,350,000
3-Apr-20 1 8 hours 1,350,000 1,350,000
6-Apr-20 1 8 hours 1,350,000 1,350,000
7-Apr-20 1 8 hours 1,350,000 1,350,000
8-Apr-20 1 8 hours 1,350,000 1,350,000
9-Apr-20 1 8 hours 1,350,000 1,350,000
10-Apr-20 1 8 hours 1,350,000 1,350,000
13-Apr-20 1 8 hours 1,350,000 1,350,000
14-Apr-20 1 8 hours 1,350,000 1,350,000
15-Apr-20 1 8 hours 1,350,000 1,350,000
16-Apr-20 1 8 hours 1,350,000 1,350,000
17-Apr-20 1 8 hours 1,350,000 1,350,000
20-Apr-20 1 8 hours 1,350,000 1,350,000
21-Apr-20 1 8 hours 1,350,000 1,350,000

Total Quantity: 15 Total Amount:

Enter this amount on Enter this amount on 20,250,000
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