CASH ADVANCE REQUEST

PT. INTAN GIRI ABADI PROJECT CODE: PI19-003

DATE 27 Oktober 2020

RECEIVED FROM PT INTAN GIRI ABADI
NAME Abdul Rahman EMPLOYEE No.
THE SUM OF Rp. 2,100,000

PURPOSE OF ADVANCE Pembelian Bakteri Bulan Oktober Ke - 3 dan Soda As

AUTHORISED BY DATE

RECEIVED BY DATE
I AGREE TO THE CONDITIONS BELOW
1 ADVANCES SHOULD BE ACCOUNTED FOR WITHIN FIVE WORKING DAYS OF RETURNING FROM BUSINESS TRAVEL.
OUTSTANDING TRAVEL ADVANCES WILL BE DEDUCTED FROM SALARY, WITHOUT NOTICE, IF NOT ACCOUNTED FOR
WITHIN SIXTY DAYS OF RECEIVING THE ADVANCE.
2 CASH ADVANCES ARE NOT TO BE USED FOR PERSONAL EXPENSES.

NO Deskripsi Qty Satuan Harga Satuan TTL Harga Keterangan

1 Pembelian Bakteri 1 minggu 1 Rp 1,750,000 Rp 1,750,000

2 Soda As 1 Rp 350,000 Rp 350,000

Rp 2,100,000
No. DESCRIPTION Qty Satuan Harga Satuan Total Harga Remark
24 November 2021
1 Uji Lab WTP @PAM JAYA 1 lot 500,000 500,000
2 Uji Lab STP @BLH Jaksel 1 lot 450,000 450,000
3 Pembelian APD: Masker Racun 3 pcs 90,000 270,000
4 Pembelian Vbelt Bando 6 pcs 125,000 750,000

Total 1,970,000
 EXPENSE CLAIM FORM DATE : =now()

PT. INTAN GIRI ABADI PROJECT CODE:

NAME : EMPLOYEE No. OFFICE / SITE : PROJECT :

DATE LOCATION ACCOMMODATION MEALS ENTERTAINMENT FARES PETROL SUNDRIES REMARKS

TOTAL CLAIM
TOTAL Rp 0 0 0 0 0 0 Rp 0.00
CURRENCY CURRENCY

COST CODES Cash Advance (Rp)

TOTAL 0 0 0 0 0 0 TOTAL CLAIM 0.00

EMPLOYEE DECLARATION: I HEREBY DECLARE THAT THIS CLAIM FOR REFURBISHMENT LESS ADVANCE 0.00
IS FOR COSTS THAT HAVE BEEN INCURRED BY ME, I ALSO
DECLARE THAT 100% OF THESE COSTS WERE INCURRED
AMOUNT DUE TO: X EMPLOYEE
FOR BUSINESS PURPOSES.
EMPLOYER

SIGNATURES 0
EMPLOYEE APPROVED BY REIMBURSEMENT RECEIVED BY
NOTE: IF EXPENSES ARE IN MORE THAN ONE CURRENCY PLEASE USE ONE FORM FOR EACH CURRENCY.
No. DESCRIPTION Qty Satuan Harga Satuan Total Harga Remark
Realisasi Biaya :
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Total 0

Cash Advance
Kekurangan 0
 Project List
PROJECT NAME DESCRIPTION PROJECT CODE

PDE - I Cementing Cementing Eqipment PO P12-001 PDE - I Cementing Eqipment

Eqipment PRC023
PDE - II Electrical Electrical Works and P12-002 PDE - II Electrical Works and
Works and Installation Installation on Barge PO Installation on Barge
on Barge PRC026
PDE - III Pembuatan Pembuatan Support Base P12-003 PDE - III Pembuatan Support Base
Support Base Frame u/ Frame u/ equipment panel Frame u/ equipment panel Control Room
equipment panel Control Control Room (PCR) (PCR)
Room (PCR)

GF-SPF2860 SPF2860 PO 4340100878 P12-003 GF-SPF2860

GPS-11 Penentuan Lokasi, Front P12-004 GPS-11
End Engineering Design
(Feed) penyusunan
Feasibility Studi Feed
SPBG di Gresik, Sidoarjo
dan Surabaya. PO PKK
20102011
SHS - SUKAMANDI 1 Pengadaan Furniture P12-005 SHS - SUKAMANDI 1
1562/SHS.06/XII/2011
SHS - SUKAMANDI 2 Perbaikan Wisma Reg I P12-006 SHS - SUKAMANDI 2
803/SHS.06/IV/2012
SHS - SUKAMANDI 3 Pengadaan Furniture PO P12-007 SHS - SUKAMANDI 3
1025/SHS.06/IV/2012
MJS - MOI-12 Pekerjaan Elektrikal, P12-008 MJS - MOI-12
elektronik, tata udara dan
Ventilasi area Food Park di
MOI. PO : 092/MJS-
MOI/V/12

MJS - MOI#2 Pengerjaan dan P12-009 MJS - MOI#2

pemasangan Intalasi Mep
di MOI PO : 140/MJS-
MOI/VIII/12
DPS-Wunut Pekerjaan Engineering, P13-001 DPS-Wunut
Contruction & Instalation
Compressed natural Gas
Plant Wunut, Porong,
Sidoarjo PO 106/DPS-
KEU/VIII/2012

GP-Duri Rekayasa, Pengadaan dan P13-002 GP-Duri

Konstruksi Sipil & Struktur
untuk CNG Plant Balai
Pungut - Duri PO
001/SPK/GP-IGA/I/13

WIKA-Egual Angle Egual Angle, WF, HB, Plat P13-003 WIKA-Egual Angle
and BNW Plus Delivery PO
Wika - Sewa Ford Sewa Ford Ranger Doble R13-001 Wika - Sewa Ford Ranger Doble
Ranger Doble Cabin XLS Cabin XLS 2.2L (4x4) MT Cabin XLS 2.2L
2.2L Single Air Bag Thn 2012
RDA-Ckrg Rekayasa, Pengadaan dan P14-001 RDA-Ckrg
Konstruksi Sipil & Struktur
untuk CNG M/S Setu -
Cikarang PO : A001/RDA-
IGA/KONTRAK/2013

TSS-001-14 Jasa Konsultasi P14-002 TSS-001-14

Penyempurnaan Data
Pertambangan PT.
Tambang Semen Sukabumi

TSS-002-14 Pekerjaan Persipan P14-004 TSS-002-14

Gambar Site Plan
Konstruksi Gardu Listrik
PT. Semen Jawa
DPS - CNG Marine CNG Marine Bawean (Long P14-005 DPS - CNG Marine Bawean
Bawean Term Contract)
(Pengadaan Jasa
Transportasi Gas Moda
CNG Ke Pula Bawean) PO :
PO-056/DPS-JKT/IX/2014
RCE-SETU-14 Rental Tru Rental Truck Pengisian R14-001 RCE-SETU-14 Rental Truck CNG
CNG (Compressesd Natural
Gas)
Cisadane - Rosemount TTS Rosemount Magnetic S14-001 Cisadane - Rosemount
Flowmeter, Install and
commissioning
PEM-15 Tube40 CNG Tube skid 40 feet P15-001 PEM-15 Tube40
GGP - Oil Tank Ground Work Mini P15-002 GGP - Oil Tank
Refunery Project Oil
Storage Tank on Gunung
gaya persada Padang
Lawas Sumut SPK
001/SPK/PR/GP-
CMJ/IV/2015 6 April 2015
PUSRI-Atap Project Atap Gudang 10 SB P15-003 PUSRI-Atap
PUSRI
ISTN-Renovasi H Pembangunan atau P15-004 ISTN-Renovasi H
Renovasi gedung H ISTN
Lanud-Perumahan Pembangunan Perumahan P15-005 Lanud-Perumahan
non dinas TNI AU LANUD
003/SPK/CDS-
IGA/II/2016 Rp
13.500.000.000
Lanud- Asrama Pembangunan Asrama P15-006 Lanud- Asrama
dinas TNI AU LANUD
Tekno1-XTrail Sewa kendaraan Nissan X- R15-001 Tekno1-XTrail
Trail B8521 OS 1 Unit
WIKA-Matidok Displacer Type Level S15-001 WIKA-Matidok
Transmitter Matidok Gas
Development, No. SPK :
TP.01.03/U.DEP.IP.MTD/0
601/II/2015 Amount

Technip-Jangkrik2 Jangkrik Complex Project - S15-002 Technip-Jangkrik2

Engineering, Procurement,
Construction and
Instalation (EPCI-2) Supply
of displacer Level
Transmitter PO : 5969N-
1552-04-0-1480 USD.
66.000,-
Technip-Jangkrik Supply Of Automation S15-003 Technip-Jangkrik
Jangkrik Complex Project
( EPCI-2 ) PO :
002/SI/PO/IGA-
DIR/VIII/15 USD.
Technip-Jangkrik Supply Of Automation S15-003 #Add1 Technip-Jangkrik
Jangkrik Complex Project
( EPCI-2 ) PO :
002/SI/PO/IGA-
DIR/VIII/15 USD.
PP - OFFICE PULAU NIAS OFFICE PULAU NIAS - P16-001 PP - OFFICE PULAU NIAS
POWER PLANT DI PULAU
NIAS IDR 1,1 M
Gagas - Tube Skid Jasa Sewa Tube Skid 40 R16-001 Gagas - Tube Skid
feet (GMT:09,08,07,04)
DPS - CNG Marine Bawea Procurement Contruction P16-002 DPS - CNG Marine Bawean #2
Fasilitas Compressed
Natural Gas (CNG) GRESIK
dan Pulau BAWEAN PO : ...
Nilai Rp 30.000.000.000
(include ppn)

CMWI - Sky Light Penggantian Sky Light Frp P16-003 CMWI - Sky Light
497 M2 PO : CMWI-
0087/PO-X/16 Rp
363.978.779,- Exclude Tax

ISO Tank - Samberah R16-002 ISO Tank - Samberah

PGASCOM-Scada Offtaake Pengadaan perangkat dan P16-004 PGASCOM-Scada Offtaake
Jasa Instalasi Scada Offtake
Semare SPK :
008500/SPK/PGASKOM/X
I/2016 Rp. 2.497.000.000,-
Incude Tax

Darmawangsa-WTP Merencanakan, W16-001 Darmawangsa-WTP

Membangun, Memelihara,
dan mengoperasikan
Waste Water Treatment
Plant (WWTP) Tarif Rp
9.500/M3 Include Tax &
Biaya Pipe line
Distribusi/Bulan Selama
24 bulan Tanpa PPN

CMWI - Atap FRP penggantian Atap Batch 2 P16-005 CMWI - Atap FRP
PO : CMWI-0306/PO-
XII/16 Rp 182.392.900,-
Exclude Tax
IKPT - Anemometer Anemometer Davis On SRI S17-001 IKPT - Anemometer
PO : 14122 -AYKL901 23
Jan 2017 IDR 60.000.000
IKPT - Pneumatic Pneumatic Controller HIC - S17-002 IKPT - Pneumatic Controller HIC -
Controller HIC - 351A, 351A, I/P Possitioner 351A, I/P Possitioner
I/P Possitioner ECKARDT On pt Pupuk
Kalimantan (Persero) PO :
K5-RUP-PO-PKG-275 18
Jan 2017 IDR 15.000.000

IKPT - Weather Station Weather Station S17-003 IKPT - Weather Station

GEI-GTM 10 Feet R17-001 GEI-GTM 10 Feet
LANUD - VIP Room P17-001 LANUD - VIP Room
DPS -ESP STATION GAS STATION GAS PLTG P17-002 DPS -ESP STATION GAS PLTG
PLTG SAMBERA SAMBERA SAMBERA
CMWI - Skylight Batch III P17-003 CMWI - Skylight Batch III
R17-002
CMWI - TPS B3 Building P17-004 CMWI - TPS B3 Building
CMWI - Cladding Work Area Moltan P17-005 CMWI - Cladding Work Area Moltan
ETI-Chasis Trailer Sewa Chasis / Bed Trailer R17-003 ETI-Chasis Trailer
Technip-Man Hour T15-004 Technip-Man Hour
IKPT - Positioner HV -106 Positioner HV -106 S17-003 IKPT - Positioner HV -106
Intelligent Positioner
(Explosion Prooof) Model
No. SRD960-
BHNDMN6FDZFA-X Rp
24.000.000 (Exclude VAT)

IKPT - Positioner Control Positioner Control Valve S17-004 IKPT - Positioner Control Valve PV
PV -104 Intelligent -104
Positioner (Explosin Proof)
Model No. SRD960-
CHNDMN6FDZFA-X Rp
26.000.000 (Exclude VAT)

PATLOG-20 40feet Sewa Head Truck 20 dan R17-004 PATLOG-20 40feet

40 feet Proyek CNG untuk
daerah Marunda, Solo,
Batang dan Nagrek
R17-004 PATLOG-20 40 feet
S17-005 Izzati - Electro Pneumatic
R16-001 Gagas - Tube Skid
Marketing
Over Head
Petty Cash - Pantry
1 21 mei 18 2jt u/ 12 vbelt bando @125K + Lab PAM Mei 2018 OK
2 3 juli 18 4570K u/ apd toolkit segam PT PAS
3 4 juli 18 1220K u/ Lab PAM dan BLH + Masker racun