£61.

00

PT IMIS PAYMENT REQUEST FORM

Accounting
RETURN TO FINANCE & ACCOUNTING DEPARTMENT
Voucher No. : 215/FIN-IMIS-BALI/IX/2023 ( -)
Date : 11 Sep 2023
Project : Klinik Intibios CAB. BALI
No PO / SPK :

CHARGED COST AMOUNT

TO CENTRE DESCRIPTION
IDR USD

Tagihan Internet Periode September 2023 ( 391,500)

ID Pelanggan ; 172401381772 a/n KLINIK INTIBIOS LAB DAN FARMASI

( -)

TOTAL ( 391,500)
Says : ENAM RATUS TIGA PULUH DUA RIBU SEMBILAN RATUS DUA RUPIAH

Budget Status Filled By F & A Dept.

Bank MANDIRI OPS (126.001.008.7590)

Over/ J.T 11/09/2023

Under No.Giro/Cheque Non Cek ; INTERNET BANKING

Verified by, Final Payment Approval

Branch Manager Fin HO Fin Dept
Request by
(Finance) Spv F A Dept. Head BOD Received by

Nurul dr. IB Alit Aisyah Lastri Alihozi Rahmawati Iman Pambagyo