F11

030420241006

BANK OUT TRANSFER REQUEST

Name, Adress, Phone of Beneficiary or Payee Reason for request

Name Arista Dewi 6/PR-SAS/IV/2024 Pembayaran bulan April 2024
Address : Business 100 Mbps (PA) 1/4/2024

City :
Phone :

Payment
Currency RP Amount Rp 1.203.200
Bank BCA In words : Satu Juta Dua Ratus Tiga ribu
Acct. No. 7725283288 Dua Ratus Rupiah
(FOR ACCOUNTING USE ONLY)
CHARGES
Coa No : FC. Amt Rp -
Coa No : FC. Amt Rp -
Coa No : FC. Amt Rp -
Coa No : FC. Amt Rp -
Coa No : FC. Amt Rp -
Coa No : FC. Amt Rp -
Coa No : FC. Amt Rp -

Requested By : Arista Dewi Approved By :

Financial Controller

Takumi Wijaya
Posted By : Arista Dewi CFO
Financial Controller

Date 3-Apr-24
Note: Please attach the relevant documents to support this request.
 PURCHASE REQUEST
Nomor: 6/PR-SAS/IV/2024

Date : 3 April 2024 Transfer By : Cash

Department : Finance V Transfer Bank
Requested By : Arista Dewi
NIP : 09021999027

Please supply the requested items:

No Item Description Reason QTY COA PRICE TOTAL

Business 100 Mbps Pembayaran bulan

1 1 Rp 1.084.001 Rp 1.084.001
(PA) 1/4/2024 April 2024

SUBTOTAL Rp 1.084.001
PPN (11%) Rp 119.240
Rounding Down Adjustment -Rp 41
TOTAL Rp 1.203.200

Requested By Approved By Declined Resived/Delayed

Financial Controller VP of People & Culture VP of People & Culture VP of People & Culture

Arista Dewi Anggarda Sanjaya Anggarda Sanjaya Anggarda Sanjaya

Bank Name : BCA

Account No : 7725283288
Name Acc bank : Arista Dewi

Remaks :
 Billing Statement
Nomor Tagihan
22258796
PT. Eka Mas Republik Invoice Number
NPWP PKP: 0033400268023000
Sinarmas Land Plaza Menara 2 Lt. 25
Jalan MH. Thamrin, Gondangdia, Menteng,
Kota Adm. Jakarta Pusat, DKI Jakarta, 10350

Solusi Anak Sakti ID Pelanggan

Customer ID
NPWP: 95.972.186.1-903.000
Jln. Dewata Gg. Vi No. 15
Denpasar, Bali 80224 C1741519
Indonesia

Tanggal Tagihan Tanggal Jatuh Tempo Jumlah Tagihan

Invoice Date Due Date Total Charges

01 Apr 2024 07 Apr 2024 Rp 1.203.200,00

Alamat berlangganan / Service Address

Jln. Dewata Gg. Vi No. 15, Denpasar, Bali 80224, Indonesia

Tanggal Detil Tagihan Jumlah

Date Billing Detail Amount (Rp)

31 Mar 2024 Tagihan sebelumnya / Previous charges 1.203.200,00

31 Mar 2024 Pembayaran / Payment - 1.203.200,00

01 Apr 2024 to Tagihan saat ini / Current charges

30 Apr 2024 Business100 Mbps (PA) - Business 100 Mbps 999.001,00
Admin Product (PA) - Admin Fee 0,00
ONT - 4Port (PA) - ONT 4 Port 30.000,00
(PL-SME) MyRepublic WIfi Hub - Prolink 0,00
Late Payment Fee 50.000,00
Administration Fee 5.000,00

Sub Total 1.084.001,00

PPN 11% / VAT 11% 119.240,00
Rounding Down Adjustment - 41,00

TOTAL 1.203.200,00

Tagihan ini kedudukannya dipersamakan dengan Faktur Pajak sesuai dengan Peraturan
Direktur Jenderal Pajak Nomor PER - 16/PJ/2021 tanggal 27 Juli 2021. Tagihan ini
dibebaskan dari pemotongan PPh Pasal 23 sesuai dengan Surat Keterangan Bebas Pemotongan
dan/atau Pemungutan PPh 23 Nomor
KET-00005/PPUT/KPP.0617/2024 tanggal 26 Februari 2024.

This invoice is considered equal to tax invoice in accordance with Regulation of

Director General of Taxes Number PER - 16/PJ/2021 dated July 27th, 2021. This invoice
is exempted from withholding tax article 23 in accordance with WHT 23 Exemption Letter
Number KET-00005/PPUT/KPP.0617/2024 dated February 26th, 2024.

1500 818 cs@myrepublic.net.id myrepublic.co.id