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DVL RS Form | Request For Sample

RFS Number : RS2023110005


SO Number : 1150000520
Requested Date : 16-November-2023 Source Plant : Darya-Varia Citeureup
Requestor : Discka Winda Syafiqah Ship To : Darya-Varia Head Office
Division : Professional Healthcare Group Reason/Program : Donation for Hermina Group
Total Amount : 16,741,575.00 Printed Date : 20 November 2023 10:41:19

PPD Code WBS Code Material Code UOM Price Qty Total Price VAT(11%) Total Price + VAT(11%)
P.23.1158.07600.20002 Q.07600.20002 50383 307,500.00 (HNA) 2,460,000.00 (HNA) 270,600.00 (HNA) 2,730,600.00 (HNA)
BOX 8
32916 Regional ROSWIN HO PHG-GPM 1 ROSWIN-PHG GPM1 ROSWIN FCT 20MG 20,610.51(SCP) 164,884.00(SCP) 18,137.00(SCP) 183,021.00(SCP)
P.23.0310.07600.20002 Q.07600.20002 50383 307,500.00 (HNA) 922,500.00 (HNA) 101,475.00 (HNA) 1,023,975.00 (HNA)
BOX 3
24616 Relief G ROSWIN HO PHG-GPM 1 ROSWIN-PHG GPM1 ROSWIN FCT 20MG 20,610.51(SCP) 61,832.00(SCP) 6,802.00(SCP) 68,634.00(SCP)
P.23.0155.07600.20002 Q.07600.20002 50383 307,500.00 (HNA) 6,150,000.00 (HNA) 676,500.00 (HNA) 6,826,500.00 (HNA)
BOX 20
23796 Winning ROSWIN HO PHG-GPM 1 ROSWIN-PHG GPM1 ROSWIN FCT 20MG 20,610.51(SCP) 412,210.00(SCP) 45,343.00(SCP) 457,553.00(SCP)
P.23.0155.07600.20002 Q.07600.20002 50382 277,500.00 (HNA) 5,550,000.00 (HNA) 610,500.00 (HNA) 6,160,500.00 (HNA)
BOX 20
23796 Winning ROSWIN HO PHG-GPM 1 ROSWIN-PHG GPM1 ROSWIN FCT 10MG 12,533.53(SCP) 250,671.00(SCP) 27,574.00(SCP) 278,245.00(SCP)
Grand Total : 16,741,575.00 (HNA)
Grand Total SPC : 987,453.00(SCP)

Approval List Approval Date


Dicky Hermawan Taslim 16-November-2023 19:29
Maulana Iman Tauchiddin 17-November-2023 14:26
Dhimas Enggar Svasono 20-November-2023 10:39
Dyah Delfiani Tri K. 17-November-2023 14:26

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