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PT.

SAMULOS RAMBUTI MAKMUR


Jl. Raya Jati Asih No. 350 Kel. Jatimekar
Kec. Bekasi 17422
Tlp : +621-21383518
Material Management
REQUEST FORM
BU : Sei Lilin

Request Date : 5 Juli 2022 Payment Date :


Request By : Arwan Fauzi Voucher No :
Job No : Department :
PO / Reff No : 003/RF/SRM/VII/2022 FA HRGA
PROD HSE
PLANT TYRE
LOG & PROC MINING

No. Description Amount


QTY Price
1 2 AC 1PK Daikin Untuk Di Office 2 Rp3,850,000 Rp 7,700,000
2 1 AC 1PK Daikin Untuk DI Container 1 Rp3,850,000 Rp 3,850,000
TOTAL Rp 11,550,000

Bank : BCA
Account Name : Arwan Fauzi
No Rek : 2311 200 293
Note :
Grand Total = Rp 11,550,000
PREPARED BY CHECKED BY APPROVED BY

Ani Aminah Yan Arwan Fauzi Aldilase Irdyansyah


Date : / / Date : / / Date : / /

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