EEE- Slirta Se Medical Centre INVOICE No 01731/FIN/MED/1X/2022 ‘Company : Ship To: PT. BARASENTOSA LESTARL PT. BARASENTOSA LESTARL Desa Balen, Kec. Rawas lr Desa Blan, Ke. Rawas Tir Kab Mus Rana Utara 31655 indonesa ab, Mut Rawas Utara 31655 Indonesia ; Perlode :3ULE 2022 ae Due Date: 29/09/2022 Description av Unie Price | Amount PO NO. 4920004476, MEDICAL DOCTOR SERVICE 1 -p0,000.000,00 pt,000.000,00 MEDICAL PARAMEDIC SERVICE 1 923,750.000,00 923750.000/00 Say: Seventy Maton Sven Hundred SityTwo Thousand Five a Tot! asus ned Ony Discount 0.00% 0,00 sts VAT Rp7.012.500,00 ‘otal ine. VAT £2p70.762.500,00 Less: Deposit 90,00 Balance Due £2970.762.500,00 ease ony arrange te poyment aftr receing te nc the along Sekar, 22/08/2022 Banker PT E-Tirta Medical Centre MANDIRI Cabang Kaw. Komersial Cilandak ‘AIC No, 070-000-001-7017 For any objections and corrections, please contact. us at foancesunimaBtitacoid within. 10deys of ‘this Invoice. we co rat receive any feedback win the stipdated period, we wil charge 20% pa. Bena iterest for everyday this invle i overdue, there's any request to transfer to other than bank account merioned in| above, please contact usa nance suprima@tia a or 021 30066508, PT. E-Tirta Medical Centre Boliagio Mall G-25, P: +6221 30066508 kawasan Mega Kuningan Barat Kav. £4.3, F: + 62 21 30066507 Jakarta Selatan 12950 wontirta cold indonesia Indonesia + Australia + Hong Kong + Malaysia + Singapore ‘Asean Healthcare Affordable & Accessible-p wv os) 4. 600449< Siirta dr. TIRTA MEDICAL CENTER JAKARTA MS SITE-BASED STAFF TIMESHEET ‘Attn : Econour Puspita (MSS Operation) Fax : +62 21 30066507 Munadi Risman Email : ekonour pussita@tita.co.id Other : this aprl en Employee Signature _/” C7 Note : assignment, sick or special leave days ? f & \ Client Site Confirmation by = Client Site Confirmation by |= Client Person Name : Petra Parulian Tambunan Employee Name : dr. MunadiRisman Client Person Name : Zulkarnaini GM/KTT Date: 31 Juli 2022 HSE Manager Doktor PT. Sinar Mas Mining (Site Bolan) Taezz Days Desertetion. TLL Tae, ay aay as ary aya] TT EO ED Bayon xp xp x] xp x] «|x| x| x] x |x| «|x| x] x] x] |x| xf xf xf xl x] xf x x] xf xl x 25 [Day off x 7 [Travel toSite: | Travel from Site: x 7 other: o| caaTemST OTA LSAT cal i Note Use an" to mark pr6 row that applies to the day whore worked, travelling, days of or other = s2 Lestarl |TIRTA MEDICAL CENTER JAKARTA ra 8 u ae a MS SITE-BASED STAFF TIMESHEET sinarmas ‘Attn : Econour Puspita (MSS Operation) Fax : +62 21 30066507 Employee Name 2 deo M. Ragit Dokter PT. Sinar Mas Mining (Site Belani ) Tukaz Description Lo Total Bist A 25] [27] a 4 [6 3) Eq [Day on x |x| x |x| x |x G Day off | [Travel toSite: | [Travel from Site = 7 lother: | TOTAL G ‘Note : Use an "X" to mark the row that applies to the day where worked, travelling, days off or other Note : For Other: this applies to special assignment, sick or special leave days Ps Employee Signature Ciont site Confirmation by :"f Client Site Confirmation by Employee Nai Client Person Name : Zulkarnaini Client Person Name : Petra Parulian Tambunan HSE Manager GM/KTT Date: 31 W022TIRTA MEDICAL CENTER JAKARTA ; MS SITE-BASED STAFF TIMESHEET sinarmas ining, ‘Attn : Econour Puspita (MSS Operation) Note Use an"X* to mark Note : For Other: this appli Employee Signature: Employee Name : Date:31 Juli 2022 ede Site inar Mas Mining (Site Blan’) Tarze pays Total Pecornten, 7m Ss) ays Tary_Ya]_Jaa] fas] as]_ya7]_qaay sa} 6] [et frol fazi [ta] [ae] [rey 20) [22] [eat [26 [28] (30) Day on x] x] x] x] xf x fe fx Pe ff fe fx Pe 73 Day off x [efx] [ef ef ee fe fee 13 Travel toSite: x 7 Travel from Site: x 7 lOther: 9 3 3 to the day where sSsignment, sick or spe ° py ; Ky. int Ste Commation by (ACB Cliont Site Confirmation by : Mekka Client Person Name : Zulkarnaini Client Person Name : Petra Parulian Tambunan HSE Manager GM/KTTPr TIRTA MEDICAL CENTER JAKARTA u rl d MS SITE-BASED STAFF TIMESHEET ‘Attn :Econour Puspita (MSS Operation) Fax : +62 21 30066507 ‘Syuhada Email Paramedic site PT. Sinar Mas Mining (Site Belani) Taree Days Deserietzon TCE ELE Sa ee ee a see TO 2] tat tet tet fo) frat [ral [ae] [rel [20] [22] [2a] [26] [2a] [30] Day on efx be fe fae fe [| | fe | x | Le 7a Day off | Travel toSie: x 7 Travel from Site: x 1 [Other: | TOTAL 29 Hote Use an % to mark the row that applies tothe day whore worked, Wraveling, days off or other Note : For Other: this applies 90 special assignment, sick or special leave days ae a : Employee Signature Client Site Confirmation by bs Client Site Confirmation by Employee Name : Syuhada Client Person Name : Zulkamaini Client Person Name : Petra Parulian Tambunan HSE Manager GM/KTT Date: 31 Juli 2022PT. BARASENTOSA LESTARI Dosa Bela, Kecamatan Rawas lr Kbupaton Musi Rawas Utara Correspondence Otic: Sinarmas Land Plaza, Menara 2 Lanai 8, .JIMH Thamrin No. 81, Kelurahan Gondangcia, Kecamatan Menieng, Jakarta Pusat Sumeter Seltn brbarasentosa Lestat indorana 1655 Prove! OX! Jkaraionela To) $01 eee Fx (621-998 3471709024708 PURCHASE ORDER PO Number 24920004475 PO Date 7 28,06:2022 To: E-TIRTAMEDICAL CENTRE, PT GED.BELLAGIO RESIDENCESMALL Delivery: PT. BARASENTOSA LESTARI category Spe. :Sumerisa Tahir (Desa Bola, Kecamatan Rawas ir JAKARTA SELATAN 12950, Ksbupaton Musi Rawas Vara Phone (62:2) st990818 Indoresia ‘Sumatera Selatan 31655 md po ae nena eee = sumerisa tahi@sinarmasmining com Fax:00 at. Freight: NPWP: 01.588-498.6-011.000 Currey ‘Syarat Pembayaran QTY VOM DUEDATE UNIT PRICE TOTAL PRICE NO ITEM CODE DESCRIPTION, oR 90 Hari dari tanggal veiikas| invoice 1 DOCTOR CHARGE DOCTOR CHARGE ‘AU 30.06.2022 40,000,000 240,000,000 Periods Jl - Desomber 2022 (6 Bulan) 2 PARAMEDIC CHARGE PARAMEDIC CHARGE Au 900062022 23,750,000 142,500,000 Periode sul - Desembor 2022 (6 Bulan) Jumiah 382,800,000 Diskon ° PPN 42,075,000 Total 424,575,000 Term & Conditions: SS AUTHORIZED SIGN ‘Nota For Supper 1. The PO number shoul be wrton on te Invoice and the Delvery Order 2. The copy PO, SES, dan GR shouldbe atached on invoice '3. The vole in cupicate should be submitto PT. BARASENTOSA LESTARI 4 Goods that do nat moet ordered specication wil be returned 5. The signed PO by supplir must be sont back to the buyer * This documents computerized, ‘signature ir required Approved ‘Apabila tora cugaan Pelanggaran Kode Etk Pengadan Barang dan Jasa, slahkan menghubungi salah satu Hotine Pengadvan berkut i (088-1511212/ hotin.procurement@sinarmasming com AGREED BY SUPPLIER Internal Note EXPR No 6200005108 Requetted by: Faisal Notes Page tof Contract Reference Cutine Agreoment No