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PT ITAMA PT ltama Ranoraya Tbk

RANORAYA TbK Head Office: MT Haryono Square Lt. I Unlt I
Jl. Otto lskandardinata Raya No_ 390 Jakarta Timur 't3330
Hi-Tech Healthcare Solutions Q +eZzt ZSOoZ:oz @ +SZzt ZS(rIZOI O www.itam..co.td

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ITAMA
Tbk lnvoice
Hi-Tech Healthcare Solutions
PT ltama Ranoraya Tbk
Head Offrce: MT Haryono Squa.e Lt. 1 Unit I
Jl. Otto lskandardlnata Raya No. 390 Jakarta T'imur 13330

O +5221 2905 7207 @ +O::r UeOo ZZos @ www.itama.co.id

INVOICE
Pf. tbna Roorayr Tbk lnwicc
MT. H.ryono Squ.rc Lt. I Unit 1Ol 4891 r 31 9 15acr-2o':11
Jt. Otto l.krnd.rdin t R.y. No.390 OdtYrry
Jak ftr Timur, 13330 30
lndonash
Srppllr/6 Rlt Othf, Rrirrdrcr(r)
Culqrrr (E3fi .03.03/UDO.PilUXzo:t1
Unlt Tru.ftr.l O.r.h P l K.b, LrnP{rng htrn t Aryc/$ frsr
Jl. lndi! Bangsa\.f,n No. 39. RT. 0(D Fl\i/. (m
No.

\rvay Urang, Kallrnda G/[G9.@,UDD.P yxr2021 15-Oct-Z)21

Kab. Lampun! Sslatan, Lampung Da3plci Dos/manl No Hv]], oa. Oda
l50ct-2021
Ocslatcncd thro{gt

Tctms of Hwry

sl Dc$ripdqt of Goo& PCI Amo{rl

No.
F
i 't rAbon HCV Hepatltis C Oev (SrP) - 4550{52173 10 Kit 530.353.00 Kit 5,30tt,530.00
: Lc! HCV008&,C Ed 3145-2oA
2 . ABON HBsAg Tcst D.vQe - 4&{fl}69(EO t0 Kit 107,591.00 Kir 4,075,9,t 0.00
Bstch . 88cle52&5 10 Ktt
,I{& Dr . 29.tu}2@l
t-
3eAp(.2023

I PPt{ 1o
9,379,.14O.m
9i17,9.14.00

Tota! mKhl
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I 0,317,384.00
; crio{rd Charlcable (in words) ,E
ihdono*fl Rtol*rTmffon Tl.l[t HlIlO.d 8.rr.rl.Jl
iTho.rsdx, Ttrx Hrndro Elgrt, fd, Ontt

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ldlt{rtcd ll|d thd rf psllicll.rt arr truG 8d co.r!d.

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This i', Co[putlr Gcncrrtad lrrvdcc F
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- Cheque Should crossed and made payable to PT ITAMA RANORAYA Tbk
- Bank Transfer to Account :

.m. : PL ITAITA iANORAYA

B.nl :,A f BNI CrbJl. P.rhdt Xrmcrdlkmn - BAI{DUI{G
Nc : m22&5&2la ( Rp }
 Faktur Pajak
Kode dan Nomor Seri Faktur Pajak : 010.007-21.4691 1319

Pengusaha Kena Pajak

Nama : PT ITAMA RANORAYA TBK.
Alamat: GEDUNG MT. HARYONO SQUARE LT.1 UNIT I, JLOTTO ISKANDARDINATA RAYA NO 390 , JAKARTA
TIMUR
NPWP : 01.385.934.3{07.000

Pembeli Barang Kena Paiak / Penerima Jasa Kena Paiak

Nama : UNIT TRANSFUSI DARAH PMI
KAB. LAMPUNG SELATAN
AIAMAT : JL. INDRA BANGSAWAN BIOK
- NO.39 RT:OOO RW:OOO KEI.WAY URANG KOC.KALIANOA KOIAiKAb.KAB.
LAMPUNG SELATAN LAMPUNG 95513
NPWP : 85.69'1.812.+325.000
Harga JuauPonggantiar/Uang
No. Nama Barang Kena Paiak / Jasa Kena Pajak
Muka/Termin
Abon HCV Hepatitis C Oev (S/P) - 4550452173
1
RD 530.353 x 10
5.303.530,00
ABON HBsAg Test Device - 4548059050
2 4.075.910,00
-RD 407.591 x 10
Harga Jual / Penggantian 9.379.440,00
Dikurangi Potongan Harga 0,00
Dikurangi Uang Muka 0,00
Dasar Pengenaan Pa.iak 9.379.440,00
PPN = 10% x Dasar Pengenaan Pajak 937.944,00
Total PPnBM (Paiak Penjualan Barang Mewah) 0,00
S$uaideng6h ketsnt ah yang bedaku, Dhehorat Jehderal Paiak m€ngatur bahwa Faktur Paiak initehh ditandafahgehl
s€cara €hklro.rik 6d naa tilak dip€dukan tanda tan96n basah pad€ Faktur Psiak ini.

JAKARTA TIMUR, 15 Oktober 2021

PRATOTO SATNO RAHARJO

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lbllrrtdr, 15 Olcobcr 2021

t{omor : (ll/1.09.01/UOO.P,{l/X/1021 v
Larnpfian
rht : Pcrmmtran Barang

Xcgdn Yth,
PT. ITAA{A R^NORAYA
Jl. Otto lslandar Rayr No. l9O, GD.
ilT. ilarprn Squarc Lantel I Unlt I
Jalrrte

Deqan lbrmrt,
Bcrdasarkan rrrrat pcruwiran brran3 yilq hp.k/lbu htrlm hcaada kaml, mak
krmr terlinl untuk mcrncran baran3 k p.d. pcrus.haan PT. lTAi{A RATORAYA
deqan spa$llLsl !!rtr h.rga yang rsual dengan yaq Eapat/lbu taurarkln hcpada
lamt. Eerikut d.rtrr b.rmg yang kaml peun :

No. Itorl Ermra Rlrrlrn Srnng Jumhh

t Abon Rea3en llCV {D Pcs
2 Abon Reagen H85AG 4(X) Pcs

Dcmikian iunt
pcrmint an baruq lni tarnl sarnpalkan, at6 perfiatirn da,l
kcrJasamanya taml weplan tcrimr kdh.

Unlt Domr Darah

1O?, zo^ PAII}IG TERAH TNDOI{ESI.A
re :46g ztar lhbupaten Lampung Selatan
[,latc r And'e- lbsi Keuangan Logistik,
T4L : tslol eoot
latg '27
qE4d,,.//
.!1'l

tJn,l Dorrr,r t)orah PMI Xdb l..rmpunH selnt.ln

Jl. lndra Ban3rawan ilo. 39 foltanda, tampunt Scl.t.n 35513
Telp. 0 72 f 32225 7 emll : utd.pmi.lamscl@gmall.com
 4t[
PT ITAI{A PT ltama Ranoraya Tbk
RANORAYA TbK Head Of6ce : MT Haryono Square Lt. 1 Unit I
Jl. Otto lskandardinata Raya No. 390 Jakarta Timur I 3330
Hi-Tech Healthcare Solutions Q +OU Zr 2906 7207 @ +6221zSOO zzoa @ www.itama.co.id

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