FORM DEKLARAS! ENTERTAINMENT
ary
Case ae cae
caer
Nama Tamu Bapak Valerian, Bapak Edwin 5 - |
= Sisue ~
“Tebing Tinga, 3 Novernver 2023
Pemohon, Mengetahui, Menyetuju,
‘Beoery rake 6.
Branéh Operation Area Manager(HO) Division Head SBO_—_ Account Owner
Head EntertainmentASME
ep. 8
ate Suto 9. 28
etan 2094
Iasiee : SIDS
rack ib
est: a8 2 ST
Tailed
an oy Heh a 2/1/20 19.13.33
Cle by Sth at 2/1178 2337.98
ry ras) ‘owt 8)
Sw Tek so.
2 ofr Ue wea.
1 cAUKDY nse Ta suc 00.08
2 been mo.00.08
2 Simin OFF sc.
1
var re 1.00,
sibel Ite. St 31.40.00
1.50.00
woes Saat 6-30.08
Total tow Du 6. 590,00
fy CRONE chiomacar (ss Date & crasie 416.986, 00
tard! Tat 4 a ath tar CU
Aware Ce: 26641
oll A
ash: TR
Jala $10 2, 3
etan 2284
ee)
Pats
Sst: UTED TACT
able ts aT a
Ahan by nt at 02713 19.050
Chg Oy Hah at 2/1/25 2.0.14
av res) mi (8)
Tem 6 A000
Stata Le. St 1.a.0n.60
os trust aa.
Tota! sar tse 1.0. 00,00
yD caesar / ion Tit A rest 1.0.0000
Card! Test sites ate mer: O88;
fear Coe: 28064)
(vest Sigmture: —___
Faptoree Staroture: