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  • Form Absen & Tanda Terima - Kabkota

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    Syifa Jessica
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    This document outlines the plans for a joint validation event between community and health service facility data from September 5-7, 2023 at the Hotel Aston Pontianak. It includes registration lists for participants, speakers, and the organizing committee. The cost input of 2.4 million rupiah is budgeted for per diems, transportation, and other meeting costs associated with the event. Receipts will be provided to distribute funds for per diems and transportation to participants.

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    This document outlines the plans for a joint validation event between community and health service facility data from September 5-7, 2023 at the Hotel Aston Pontianak. It includes registration lists for participants, speakers, and the organizing committee. The cost input of 2.4 million rupiah is budgeted for per diems, transportation, and other meeting costs associated with the event. Receipts will be provided to distribute funds for per diems and transportation to participants.

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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    1 views9 pages

    Form Absen & Tanda Terima - Kabkota

    Uploaded by

    Syifa Jessica
    This document outlines the plans for a joint validation event between community and health service facility data from September 5-7, 2023 at the Hotel Aston Pontianak. It includes registration lists for participants, speakers, and the organizing committee. The cost input of 2.4 million rupiah is budgeted for per diems, transportation, and other meeting costs associated with the event. Receipts will be provided to distribute funds for per diems and transportation to participants.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 9

    Module : Treatment, care and support

    Budget Line : 238


    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    DAFTAR REGISTRASI PESERTA


    Joint Validation of Community Data With Health Service Facility Data

    No. Nama Instansi Jabatan No Telepon Tanda Tangan

    10

    11

    12

    13
    Module : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    DAFTAR REGISTRASI PESERTA


    Joint Validation of Community Data With Health Service Facility Data

    No. Nama Instansi Jabatan No Telepon Tanda Tangan

    14

    15

    16

    17

    18

    19

    20

    Dibuat Oleh : Diketahui Oleh :

    (Lia Susanti) (Sy. Rizal Alkadrie)


    Keuangan IU Koordinator IU
    Module : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    DAFTAR HADIR PESERTA


    Joint Validation of Community Data With Health Service Facility Data
    Pontianak, 5 September 2023

    No. Nama Instansi Jabatan No Telepon Tanda Tangan

    10

    11

    12

    13
    Module : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    DAFTAR HADIR PESERTA


    Joint Validation of Community Data With Health Service Facility Data
    Pontianak, 5 September 2023

    No. Nama Instansi Jabatan No Telepon Tanda Tangan

    14

    15

    16

    17

    18

    19

    20

    Dibuat Oleh : Diketahui Oleh :

    (Lia Susanti) (Sy. Rizal Alkadrie)


    Keuangan IU Koordinator IU
    Module : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    DAFTAR HADIR NARASUMBER


    Joint Validation of Community Data With Health Service Facility Data
    Pontianak, 5 September 2023

    No. Nama Jabatan Instansi / Lembaga No Telepon Alamat Email Tanda Tangan

    Dibuat Oleh : Diketahui Oleh :

    (Lia Susanti)
    Keuangan IU (Sy. Rizal Alkadrie)
    Koordinator IU
    Module : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    DAFTAR HADIR PANITIA


    Joint Validation of Community Data With Health Service Facility Data
    Pontianak, 5 September 2023

    No. Nama Jabatan Instansi / Lembaga No Telepon Alamat Email Tanda Tangan

    Dibuat Oleh : Diketahui Oleh :

    (Lia Susanti)
    Keuangan IU (Sy. Rizal Alkadrie)
    Koordinator IU
    TANDA TERIMA
    Telah diterima dari Yayasan Pontianak Plus
    Untuk Pembayaran Perdiem dan Transport
    Modul : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    No Keterangan Perincian Biaya Keterangan


    1 Perdiem @ Rp 95,000 x 3 hari Rp 285,000
    2 Transportasi
    2.1 local Transport @ Rp 100,000 x 3 hari Rp 300,000
    Total Rp 585,000

    Diberikan kepada : Tanda tangan Penerima,


    Nama : (diisi sesuai nama peserta)
    Jabatan : Peserta
    Kab/Kota : contoh: Kota Pontianak
    Tanggal : (diisi hari terakhir kegiatan) (diisi sesuai nama peserta)
    TANDA TERIMA
    Telah diterima dari Yayasan Pontianak Plus
    Untuk Pembayaran Perdiem dan Transport
    Modul : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    No Keterangan Perincian Biaya Keterangan


    1 Fee @ Rp 500,000 x 1 hari Rp 500,000
    2 PPh 21 atas Fee @ Rp 12,500 x 1 hari Rp (12,500)
    3 Transportasi
    3.1 local Transport @ Rp 100,000 x 1 hari Rp 100,000
    Total Rp 587,500

    Diberikan kepada : Tanda tangan Penerima,


    Nama : (diisi sesuai nama Narsum)
    Jabatan : Narasumber
    Kab/Kota : Pontianak (Kalimantan Barat)
    Tanggal : (diisi hari terakhir kegiatan) (diisi sesuai nama Narsum)
    TANDA TERIMA
    Telah diterima dari Yayasan Pontianak Plus
    Untuk Pembayaran Perdiem dan Transport
    Modul : Treatment, care and support
    Budget Line : 238
    Intervention : Counseling and psycho-social support
    Cost Input : 2.4 Meeting/Advocacy related per diems/transport/other costs
    Aktivitas : Joint Validation of Community Data With Health Service Facility Data
    Tanggal Pelaksanaan : 5 - 7 September 2023
    Tempat Pelaksanaan : Hotel Aston Pontianak

    No Keterangan Perincian Biaya Keterangan


    1 Perdiem @ Rp 95,000 x 3 hari Rp 285,000
    2 Transportasi
    2.1 local Transport @ Rp 100,000 x 3 hari Rp 300,000
    Total Rp 585,000

    Diberikan kepada : Tanda tangan Penerima,


    Nama : (diisi sesuai nama panitia)
    Jabatan : Panitia
    Kab/Kota : Pontianak (Kalimantan Barat)
    Tanggal : (diisi hari terakhir kegiatan) (diisi sesuai nama panitia)

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