CIRCLE K INDONESIA

House Fund Receipt

This is to certify that,Mr Edi Ariasa ( ADP ) ,have received from the Circle K Indonesia
Utama, a cash float in the amount of Rp.1,500,000,- in word One Million Five Hundred
Thousand Rupiah
solely to be used in my duties as Area Koordinator, CK Drupadi Dento New
I understand and agree that the money are the property of the Circle K and agree to
surrender such cash and other issued items on demand. I agree that I am personally
responsible for the total fund during the period that it is assigned to me. I also agree that
the cash may be counted and checked by any individual authorized by management at
any time.

I will provide Income Auditor a report as to the condition of this fund on the form
provided to me as and when needed.

I understand that any deviation from the above or other company cash handling
procedures will be considered a violation of the company rules and will constitute
grounds for my immediate dismissal.
I have read and acknowledge the policy and procedures of this form.

Signed – Employee

Edi Ariasa ( ADP )

Authorized by:

Department Head General Manager

Sandy Gerhanda Rasu Iwan Setyawan

Issued by:

Regional Controller
Chandra
 CIRCLE K INDONESIA

Rincian :

Nominal
NO OUTLET AK 500 1,000 5,000 10,000 20,000 TOTAL
CK
Drupadi Edi Ariasa
Dento
1 New 100,000 300,000 400,000 500,000 200,000 1,500,000