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LAPORAN KLAIM BERDASARKAN BENGKEL

Periode Tanggal Aksep '. 1nnA16 sld 41312016

No. Referensi : 000215i00100029451ffir2A1UMAU No. NPWP : 1000

14802891331 Tanggal . 041A312016

Nama : SPEED BODY REPAIR Nama NPWP . HENDRO Waktu . 9:52:23

Bengkel {BENGKULU)
AIAMAT : JL, RAFLESIA SIMPANG EMPAT AIAMAI : JL, WIJAYA KUSUMA NO.25
BengKeI PANTI BENGKULU NPWP RT12 RWO4 BENGKULU
Kepada : HENDRO
Nomor : 0032851 169 - BANK SINARMAS
Account

No No. Akseptasi Nama Tertanggung Klaim Diaksep: Keterangan -Jasa Pph Jasa Jumlah
No. Polis Tgl Kejadian O$n Damage €parepart Klaim
No. Wo Tgl. Pelunasan Premi .T.P.L -Material Dibayar
No. Kwitansi No" Plat -PPn (NET)
1 A022292016C2A1H72AC f,TO RO BENGKULU QQ MARYANCE NET 2.200.000 oR 900.000 2.200 000 44 000 1.256 000
SELVENI 0
02229201544894 16101t2016 0 0
0461 640073 )5t02nu5 TPL O
3D1287C4 0

2. 4022292416C241H721C 3TO RO BENGKULU QQ MARYANCE NET 285.000 OR 0 285.000 5.700 279.340

SELVENI 0
42229241540094 36/a1t2016 0 TPL O 0
046 1 6A022S 35tA2t2015
BD1287CA 0
e 40222920160201 H867C OTO RO BENGKULU QQ DERAN ANIS NET 522.750 oR 200.000 522.750 10.455
13t01t2016 0
02229201 30088S '1510812013 0
046 1 6A01 68 BD1 348AV TPL O
c

4. A022292A16C20 1 H9 1 9C OTO RO BENGKULU QO DEDDY NET 1.547.750 oR 400.000 1.547 .754 30.s55 1.116.795
OSMADI, A.MD,KEP 0
02229201 300806 zIultluta 0 0
04616A0227 30t07t2013 TDI N

BD1 3O2BA 0

5 A02046201 60201 HS47C PT BCA FINANCE QO BCA QQ ANWAR NET 1.490.000 oR 400.000 1 490.000 29 800 1.060.200
SADAT QQ ANWAR SADAT 0
02046201 300542 30tutza16 0 0
046 1 6A0290 02107t2013 TPL O
BD1 831AS 0

4424462016C701 HS48C BCA FINANCE, PT QQ BCA OQ ARNUS NET 507.750 oR 400.000 507.750 1 0.1 55 07 60q
ANAS 0
02446241241300 2BIUt2A16 0 0
0461 6A027S 26{02nU3 TPL O
BD1656AR 0

7 AA2A462016C201 H949C PT BCA FINANCE QQ BCA QQ NET 2.032.000 oR 400.000 2.032.000 40.640 1.591.360
NAZARUDIN OO NAZARUDIN 0
02046201200169 19t12/2015 0 0
046 1 5075B7 16t44t2412 TDI N

BD1738AO 0

40204620160201 H950C PT BCA FINANCE OO BCA OO NET 920 s00 oR 300 000 920.500 18.410 602.090
SEMARAN QQ SEMARAN 0
02046201 5001 59 13tUt2A16 0 0
04616A01 09 20t04t2015 TPL O
BD 1 447CB 0

402046201 6020 1 H951 C PT BCA FINANCE OO BCA QQ NET 150.000 oR0 1 50.000 3.000 1 47.000
SEMARAN QQ SEMARAN 0
02046201 5001 59 13t01t2016 0 TPL O 0
046 1 6A0297 20t04t2015
8D1447t8 0

10. 4020462416020 H993C PT BCA FINANCE OO BCA OO

1 NET 910 000 OR 400.000 91 0.000 18.200 491.800
ROSNAINI QQ ROSNAINI 0
02046201 200891 26t1?t2015 0 0
04615A7642 12t10t2012 TPL O
BD1455AQ 0

11 A02046201 60201 H995C GUSTINAWATI NET 685 000 oR 300.000 385.000 13.740 371.300
11t42t2016 3
02046201504722 13!07t2015 0 3
0461 640380
on I a-aan TPL O
0

12. 4020462U64201 r01 1C BCA FINANCE, PT QQ BCA QQ YUNG NET 678.500 oR 200.000 13.570 464.930
02046201 300734 BERZANDI S 0
046 1 640340 a7ta2t2a16 0
14108t2013 TPL O
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