LAPORAN TRANSAKSI FINANSIAL

STATEMENT OF FINANCIAL TRANSACTION

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Tanggal Laporan : 17/04/24

Kepada Yth. / To : Statement Date

HASNA RAIZA DARIZKI Periode Transaksi : 01/02/24 - 29/02/24

Transaction Periode

KP PAKU,Rt.4/3,BOGOR LEUWISADENG BOGOR

No. Rekening : 227401000385568 Unit Kerja : KCP LEUWILIANG

Account No Business Unit

Nama Produk : BritAma Bisnis Alamat Unit Kerja : Jl.Raya Leuwiliang No.15-16
Product Name Business Unit Address Kec.Leuwiliang Kab.Bogor

Valuta : IDR
Currency

Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo

Transaction Date Transaction Description User ID Debit Credit Balance

01/02/24 19:24:21 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888039 100,000.00 0.00 368,933.00
BRImo

02/02/24 10:24:21 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888198 100,000.00 0.00 268,933.00
BRImo

02/02/24 11:50:54 Top Up DANA 0857xxxx457 AKMXX DWI via BRImo 8888162 55,000.00 0.00 213,933.00

02/02/24 20:09:15 Top Up Gopay+62857xxxx289 via BRImo 8888438 1,000.00 0.00 212,933.00

02/02/24 20:09:15 Top Up Gopay+62857xxxx289 via BRImo 8888438 10,000.00 0.00 202,933.00

03/02/24 16:49:51 NP 16609 000004074 0888153 100,000.00 0.00 102,933.00

04/02/24 05:20:58 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890402 0.00 1,900,000.00 2,002,933.00

04/02/24 06:10:52 BFST0055891443 NBMB:SBJKIDJA 8888524 2,500.00 0.00 2,000,433.00

04/02/24 06:10:52 BFST0055891443 NBMB:SBJKIDJA 8888524 1,600,000.00 0.00 400,433.00

04/02/24 10:27:27 Top Up OVO 0857xxxx289 HA**A RA** via BRImo 8888252 120,000.00 0.00 280,433.00

04/02/24 16:25:12 BFST0055891443 NBMB:SBJKIDJA 8888485 2,500.00 0.00 277,933.00

04/02/24 16:25:12 BFST0055891443 NBMB:SBJKIDJA 8888485 100,000.00 0.00 177,933.00

05/02/24 06:11:14 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888584 58,000.00 0.00 119,933.00
BRImo

05/02/24 11:13:12 BFST227401000385568HASNA RAIZA :SBJKIDJA 8888675 0.00 35,000.00 154,933.00

05/02/24 11:13:32 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888434 35,000.00 0.00 119,933.00
BRImo

05/02/24 11:39:24 Top Up Gopay+62857xxxx289 via BRImo 8888118 1,000.00 0.00 118,933.00

05/02/24 11:39:24 Top Up Gopay+62857xxxx289 via BRImo 8888118 20,000.00 0.00 98,933.00

06/02/24 09:52:13 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890408 0.00 2,000,000.00 2,098,933.00

06/02/24 09:52:46 Beli Token PLN 14356104357 via BRImo 8888350 3,000.00 0.00 2,095,933.00

06/02/24 09:52:46 Beli Token PLN 14356104357 via BRImo 8888350 200,000.00 0.00 1,895,933.00

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 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

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Page 2 of 5
Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

06/02/24 21:08:53 Top Up Gopay+62857xxxx289 via BRImo 8888304 1,000.00 0.00 1,894,933.00

06/02/24 21:08:53 Top Up Gopay+62857xxxx289 via BRImo 8888304 100,000.00 0.00 1,794,933.00

06/02/24 21:11:21 Top Up DANA 0882xxxx957 WINX HERX via BRImo 8888582 200,000.00 0.00 1,594,933.00

06/02/24 21:23:45 Top Up DANA 0857xxxx289 HASXX RAI via BRImo 8888437 30,000.00 0.00 1,564,933.00

07/02/24 14:39:16 Pembayaran Merchant SUSHI TEI BOTANI SQUARE 0852981 547,498.00 0.00 1,017,435.00
via EDC 10590583

07/02/24 16:14:10 NP 35474 000001597 0888154 41,600.00 0.00 975,835.00

07/02/24 16:26:10 Pembayaran Merchant HOP HOP BOTANI SQUARE 0852769 58,000.00 0.00 917,835.00
BOGOR via EDC 10324753

07/02/24 18:11:01 5326595014799600#645731463188#NBMB#TRFLA 8888188 6,500.00 0.00 911,335.00

07/02/24 18:11:01 5326595014799600#645731463188#NBMB#TRFLA 8888188 290,000.00 0.00 621,335.00

11/02/24 01:19:11 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890401 0.00 4,200,000.00 4,821,335.00

11/02/24 02:41:17 Pembayaran Tokopedia 0812xxxx898 via BRImo 8888417 1,946,458.00 0.00 2,874,877.00

11/02/24 02:43:10 BFST397120624128885889NBMB:CENAIDJA 8888468 2,500.00 0.00 2,872,377.00

11/02/24 02:43:10 BFST397120624128885889NBMB:CENAIDJA 8888468 849,110.00 0.00 2,023,267.00

11/02/24 14:52:24 Top Up DANA 0882xxxx957 WINX HERX via BRImo 8888412 400,000.00 0.00 1,623,267.00

11/02/24 17:44:41 Top Up DANA 0882xxxx957 WINX HERX via BRImo 8888076 50,000.00 0.00 1,573,267.00

11/02/24 20:45:14 Top Up Shopee 0882xxxx957 wXXXXXXXXXXXXXXX 8888238 40,000.00 0.00 1,533,267.00
via BRImo

13/02/24 11:14:52 Top Up Gopay+62857xxxx289 via BRImo 8888453 1,000.00 0.00 1,532,267.00

13/02/24 11:14:52 Top Up Gopay+62857xxxx289 via BRImo 8888453 30,000.00 0.00 1,502,267.00

13/02/24 16:08:21 532659501479960000058338 9850030 1,250,000.00 0.00 252,267.00

15/02/24 08:46:10 Transfer Dari HASNA RAIZA DA via BRImo 8888117 0.00 100,000.00 352,267.00

15/02/24 08:50:38 532659501479960000058338 9850030 300,000.00 0.00 52,267.00

15/02/24 13:30:35 BFST227401000385568HASNA RAIZA :SBJKIDJA 8888669 0.00 100,000.00 152,267.00

15/02/24 13:32:27 Top Up Shopee 0858xxxx787 aXXXXXXXXX3 via 8888255 50,000.00 0.00 102,267.00
BRImo

15/02/24 17:05:02 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890405 0.00 2,000,000.00 2,102,267.00

15/02/24 17:08:14 Beli Token PLN 14356104357 via BRImo 8888107 3,000.00 0.00 2,099,267.00

15/02/24 17:08:14 Beli Token PLN 14356104357 via BRImo 8888107 200,000.00 0.00 1,899,267.00

15/02/24 17:12:48 Top Up Gopay+62857xxxx289 via BRImo 8888138 1,000.00 0.00 1,898,267.00

15/02/24 17:12:48 Top Up Gopay+62857xxxx289 via BRImo 8888138 200,000.00 0.00 1,698,267.00

16/02/24 14:53:12 Top Up Gopay+62857xxxx289 via BRImo 8888074 1,000.00 0.00 1,697,267.00

04/17/2024 09:50:06
 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

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Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

16/02/24 14:53:12 Top Up Gopay+62857xxxx289 via BRImo 8888074 50,000.00 0.00 1,647,267.00

16/02/24 15:01:40 BFST0055891443 NBMB:SBJKIDJA 8888036 2,500.00 0.00 1,644,767.00

16/02/24 15:01:40 BFST0055891443 NBMB:SBJKIDJA 8888036 200,000.00 0.00 1,444,767.00

17/02/24 08:02:40 Beli Token PLN 14406539560 via BRImo 8888511 3,000.00 0.00 1,441,767.00

17/02/24 08:02:40 Beli Token PLN 14406539560 via BRImo 8888511 20,000.00 0.00 1,421,767.00

17/02/24 11:39:02 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888566 200,000.00 0.00 1,221,767.00
BRImo

17/02/24 11:46:22 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888481 30,000.00 0.00 1,191,767.00
BRImo

17/02/24 17:10:23 Transfer Ke TAKLIB S via BRImo 8888275 120,000.00 0.00 1,071,767.00

17/02/24 21:07:48 Pembayaran Merchant ALFAMART XB03 SEMESTA 0852930 29,200.00 0.00 1,042,567.00
DRAMAGA via EDC 10447753

17/02/24 21:08:45 5326595014799600000091361606 0888303 7,500.00 0.00 1,035,067.00

17/02/24 21:08:45 5326595014799600000091361606 0888303 100,000.00 0.00 935,067.00

18/02/24 10:19:07 Top Up OVO 0857xxxx289 HA**A RA** via BRImo 8888417 100,000.00 0.00 835,067.00

18/02/24 14:31:45 Bayar QRIS 8888416 26,000.00 0.00 809,067.00

18/02/24 16:08:07 Top Up OVO 0857xxxx289 HA**A RA** via BRImo 8888095 100,000.00 0.00 709,067.00

19/02/24 11:55:39 Pembayaran Tokopedia 0812xxxx898 via BRImo 8888343 102,500.00 0.00 606,567.00

20/02/24 17:52:13 Top Up Gopay+62857xxxx289 via BRImo 8888207 1,000.00 0.00 605,567.00

20/02/24 17:52:13 Top Up Gopay+62857xxxx289 via BRImo 8888207 100,000.00 0.00 505,567.00

20/02/24 17:54:28 Top Up OVO 0857xxxx289 HA**A RA** via BRImo 8888601 100,000.00 0.00 405,567.00

20/02/24 23:59:59 Minimum Balance Fee 50,000.00 0.00 355,567.00

21/02/24 12:38:41 Pembayaran Tokopedia 0812xxxx898 via BRImo 8888469 126,500.00 0.00 229,067.00

21/02/24 19:19:30 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890407 0.00 500,000.00 729,067.00

21/02/24 19:22:01 Beli Token PLN 14356104357 via BRImo 8888095 3,000.00 0.00 726,067.00

21/02/24 19:22:01 Beli Token PLN 14356104357 via BRImo 8888095 200,000.00 0.00 526,067.00

22/02/24 16:17:12 Top Up DANA 0882xxxx957 WINX HERX via BRImo 8888091 100,000.00 0.00 426,067.00

24/02/24 16:39:19 NP 16609 000004170 0888165 157,000.00 0.00 269,067.00

25/02/24 01:39:38 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890410 0.00 600,000.00 869,067.00

25/02/24 20:30:36 BFST1330022592372 NBMB:BMRIIDJA 8888014 2,500.00 0.00 866,567.00

25/02/24 20:30:36 BFST1330022592372 NBMB:BMRIIDJA 8888014 471,800.00 0.00 394,767.00

26/02/24 10:48:24 Top Up DANA 0882xxxx957 WINX HERX via BRImo 8888082 150,000.00 0.00 244,767.00

26/02/24 12:54:49 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890404 0.00 2,000,000.00 2,244,767.00

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 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

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Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

26/02/24 12:56:59 BFST0055891443 NBMB:SBJKIDJA 8888076 2,500.00 0.00 2,242,267.00

26/02/24 12:56:59 BFST0055891443 NBMB:SBJKIDJA 8888076 1,000,000.00 0.00 1,242,267.00

26/02/24 14:55:31 Top Up Gopay+62857xxxx289 via BRImo 8888583 1,000.00 0.00 1,241,267.00

26/02/24 14:55:31 Top Up Gopay+62857xxxx289 via BRImo 8888583 100,000.00 0.00 1,141,267.00

26/02/24 20:25:02 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890402 0.00 4,000,000.00 5,141,267.00

27/02/24 10:09:41 BFST8720197171 NBMB:CENAIDJA 8888182 2,500.00 0.00 5,138,767.00

27/02/24 10:09:41 BFST8720197171 NBMB:CENAIDJA 8888182 350,000.00 0.00 4,788,767.00

27/02/24 19:34:30 Pembayaran Tokopedia 0812xxxx898 via BRImo 8888305 320,998.00 0.00 4,467,769.00

27/02/24 20:03:04 BFST0055891443 NBMB:SBJKIDJA 8888028 2,500.00 0.00 4,465,269.00

27/02/24 20:03:04 BFST0055891443 NBMB:SBJKIDJA 8888028 2,700,000.00 0.00 1,765,269.00

27/02/24 20:47:53 Top Up DANA 0857xxxx289 HASXX RAI via BRImo 8888063 20,000.00 0.00 1,745,269.00

27/02/24 22:29:30 Top Up DANA 0857xxxx289 HASXX RAI via BRImo 8888035 20,000.00 0.00 1,725,269.00

28/02/24 11:45:23 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888571 160,000.00 0.00 1,565,269.00
BRImo

28/02/24 11:47:53 Top Up DANA 0882xxxx957 WINX HERX via BRImo 8888220 300,000.00 0.00 1,265,269.00

28/02/24 12:49:00 Pembayaran Tokopedia 0812xxxx898 via BRImo 8888030 102,500.00 0.00 1,162,769.00

29/02/24 12:46:12 5326595014799600#653972474133#NBMB#TRFLA 8888590 6,500.00 0.00 1,156,269.00

29/02/24 12:46:12 5326595014799600#653972474133#NBMB#TRFLA 8888590 110,000.00 0.00 1,046,269.00

29/02/24 15:23:50 5326595014799600#654039373979#NBMB#TRFLA 8888095 6,500.00 0.00 1,039,769.00

29/02/24 15:23:50 5326595014799600#654039373979#NBMB#TRFLA 8888095 200,000.00 0.00 839,769.00

29/02/24 15:55:17 Top Up Shopee 0857xxxx289 hXXXXXXXXXX8 via 8888387 160,000.00 0.00 679,769.00
BRImo

29/02/24 21:25:42 BFST20701500094591 NBMB:BTANIDJA 8888026 2,500.00 0.00 677,269.00

29/02/24 21:25:42 BFST20701500094591 NBMB:BTANIDJA 8888026 100,000.00 0.00 577,269.00

29/02/24 22:19:02 IBIZ JAYATI DELAPAN TO HASNA RAIZA DARIZ 8890406 0.00 14,000,000.00 14,577,269.00

29/02/24 22:31:50 5326595014799600#654235270841#NBMB#TRFMP 8888086 6,500.00 0.00 14,570,769.00

29/02/24 22:31:50 5326595014799600#654235270841#NBMB#TRFMP 8888086 7,405,600.00 0.00 7,165,169.00

Saldo Awal Total Transaksi Debet Total Transaksi Kredit Saldo Akhir
Opening Balance Total Debit Transaction Total Credit Transaction Closing Balance

468,933.00 24,738,764.00 31,435,000.00 7,165,169.00

Terbilang / In Words

TUJUH JUTA SERATUS ENAM PULUH LIMA RIBU SERATUS ENAM PULUH SEMBILAN RUPIAH
SEVEN MILLION ONE HUNDRED SIXTY FIVE THOUSAND ONE HUNDRED SIXTY NINE RUPIAH

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 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

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Biaya materai telah dibayar Lunas
Revenue Stamp Paid

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04/17/2024 09:50:06