GUEST FOLIO

Name and Address

Ninik Nurhidayah,
Indri Kusuma Dewi,

Company Name : Poltekkes Kemenkes Surakarta

Arrival Date : 14 Nov 2021

Room No : 2518 Departure Date : 16 Nov 2021
No Of Person : 1 Folio Number : 00606176/ALL
C/O Time : 12:00 Payment Term : CASH

No Date Description Debit Credit

1. 14/11/21 Room Package 1.000.000

14/11/21 Fullboard Meeting 600.000
2 15/11/21 Room Package 1.000.000
15/11/21 Fullboard Meeting 600.000

Total 3.200.000
3.200.000

Total Balance
0

Saya menyatakan bersedia bertanggung jawab atas biaya-biaya yang timbul

dan bersedia secara pribadi menanggung biaya-biaya dimana perorangan, perusahaan atau asosiasi
yang ditunjuk tidak menyelesaikan sebagian atau seluruh dari biaya-biaya tersebut.

I agree that my liability for this bill is not waived and I agree to be held personally liable in the event that the indicated person, company
or association fails to pay for any part or the full amount of these charges.

TANDA TANGAN TAMU

GUEST SIGNATURE

Jalan Pantai Indah, Ancol Jakarta Baycity, Jakarta Utara 14430, Indonesia
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