Booking.com B.V.

P.O. Box 1639

1000 BP Amsterdam
The Netherlands
Faks:
Telepon:
+622130438721Bahasa/+622130438722English
grand malaka ethical hotel No. PPN: NL805734958B01
Subia Oktiana Terdaftar di Amsterdam dengan Nomor:
Jalan malaka II no. 05 kel. bukit sangkal kec. Kalidoni 31047344
30118 Palembang www.booking.com
Indonesia

Nomor akomodasi: 1016772

Nomor faktur : 1524940931
Tanggal: 03/05/18
Periode: 01/04/18 - 30/04/18

FAKTUR
Deskripsi Penjualan Kamar Komisi

Pemesanan IDR 15200000 IDR 2280000

Jumlah total IDR 2280000

Tanggal Jatuh Tempo: 16 Mei 2018

Silakan transfer jumlah total uang ke rekening bank kami di bawah ini sebelum tanggal Jatuh Tempo Pembayaran.
Harap pastikan untuk menyertakan nomor Faktur 1524940931 dan nomor akomodasi 1016772 sesuai dengan prosedur
pembayaran Anda.

PT Bank Mandiri (Persero), Tbk

Plaza Mandiri, Jl. Jend. Gatot Subroto Kav. 36-38,
Jakarta 12190
SWIFT : BMRIIDJA
SKN Clearing Code: 0080017
ACCOUNT: 8887501016772
ACCOUNT HOLDER: Booking.com B.V.
ACCOUNT CURRENCY: IDR

Payment should be made in (IDR) Indonesian Rupiah only

HARAP PERHATIKAN BAHWA INVOICE KAMI DIDASARKAN PADA TANGGAL KEPERGIAN DAN BUKAN
TANGGAL KEDATANGAN.

Untuk ringkasan reservasi lengkap silakan login ke Ekstranet Anda (http://www.booking.com/hotelaccess), buka tab
Keuangan dan klik "Laporan Reservasi".

Untuk pertanyaan terkait keuangan dan invoice, silakan kunjungan PUSAT BANTUAN MITRA kami
Part IV INDONESIA WITHHOLDING AGENT

Tax ID Number :
Name :

Full address :
Contact Number : email :

Part V TO BE COMPLETED IF THE INCOME RECIPIENT IS AN INDIVIDUAL

1. Name of Income Recipient :
2. Date of birth (mm/dd/yyyy) : / /

3. Full address :
4. One of the principal purpose of the arrangements or transactions is to obtain Yes No
benefit under the convention and contrary to the object and purpose of the DTC
5. Are you acting as an agent or a nominee? Yes No
6. Do you have permanent home in Indonesia? Yes No
7. In what country do your ordinarily reside?

8. Have you ever been resided in Indonesia? Yes No

If so, in what period? / / to / /

Please provide the address :

9. Do you have any office, or other place of business in Indonesia? Yes No

If so, please provide the address :

Part VI TO BE COMPLETED IF THE INCOME RECIPIENT IS NON INDIVIDUAL

1. Country of registration/incorporation : The Netherlands

2. Which country does the place of management or control reside? The Netherlands

3. Address of Head Office : Herengracht 597, 1017 CE Amsterdam

4. Address of branches, offices, or other place of business in Indonesia (if any) :

n/a

5. One of the principal purpose of the arrangements or transactions is to obtain Yes v No

benefit under the convention and contrary to the object and purpose of the DTC
6. There are relevant economic motives or other valid reasons for the v Yes No
establishment of the foreign entity
7. The entity has its own management to conduct the business and v Yes No
such management has an independent discretion.
8. The entity has sufficient assets to conduct business other than the assets v Yes No
generating income from Indonesia.
9. The entity has sufficient and qualified personnel to conduct the business. v Yes No
10. The entity has business activity other than receiving dividend, interest, v Yes No
royalty sourced from Indonesia.

I declare that I have examined the information provided in this form and to the best of my knowledge and belief it is
true, correct, and complete. Official Stamp (if any)

Amsterdam , 05 / 03 / 18 Manager
Signature of the income recipient or individual Place, date (mm/dd/yy) Capacity in which acting
authorized to sign for the income recipient

This form is available and may be downloaded at this website: http:/www.pajak.go.id

DGT-1 Page 2
 TO BE COMPLETED IF THE INCOME EARNED ARE DIVIDEND, INTEREST
Part VII
OR ROYALTY

1. The entity is acting as an agent, nominee or conduit Yes No

2. The entity has controlling rights or disposal rights on the income Yes No
or the assets or rights that generate the income.
3. No more than 50 per cent of the entity's income is used to satisfy claims by Yes No
other persons.

4. The entity bear the risk on its own asset, capital, or the liability Yes No
5. The entity has contract/s which obliges the entity to transfer the income Yes No
received to resident of third country.

INCOME EARNED FROM INDONESIA IN RESPECT TO WHICH RELIEF

Part VIII
IS CLAIMED
1. Dividend, Interest, or Royalties:
a. Type of income :

b. Amount of income liable to withholding tax under Indonesian Law : IDR

c. Amount of income liable to withholding tax under DTC :

Amount : Percentage :

2. Income from rendering services (including professional):

a. Type of income : Commissions
b. Amount of income liable to withholding tax under Indonesian Law : IDR

c. Amount of income liable to withholding tax under DTC :

Amount : Percentage :

d. Period of engagement (mm/dd/yy) :

/ / to / /
/ / to / /
/ / to / /
/ / to / /

3. Other Type of Income

a. Type of income :

b. Amount of income liable to withholding tax under Indonesian Law : IDR

c. Amount of income liable to withholding tax under DTC :
Amount : Percentage :

I declare that I have examined the information provided in this form and to the best of my knowledge and belief it is
true, correct, and complete. Official Stamp (if any)

Amsterdam , 05 / 03 / 18 Manager
Signature of the income recipient or individual Place, date (mm/dd/yy) Capacity in which acting
authorized to sign for the income recipient

This form is available and may be downloaded at this website: http:/www.pajak.go.id

DGT-1 Page 3