MASTER ATM BRI BANJARMASIN

MERK
NO ATM ID CTR LOKASI ATM DENOM KELOLAAN
ATM

16 57942 4 RINDAM 50,000 HYOSUNG SSI BJB

18 94513 4 POLRES BANJAR 100,000 NCR SSI BJB
19 94515 4 SPN BANJARBARU 100,000 NCR SSI BJB
20 51656 4 PUBLIC MM AZ-ZAHRA 50,000 WINCOR SSI BJB
21 54395 4 BJM KEVIN RESORT 100,000 WINCOR SSI BJB
23 94514 4 POLTEKES BJB 50,000 NCR SSI BJB
24 81282 4 BPKP BJB 100,000 WINCOR SSI BJB
33 80911 4 POLDA KALSEL 50,000 WINCOR SSI BJB
35 91016 4 BANDARA SYAMSUDIN NOOR 100,000 WINCOR SSI BJB
62 350656 4 PLAZA FUTSAL 50,000 HYOSUNG SSI BJB
67 57056 4 SPBU KM.19 100,000 HYOSUNG SSI BJB
68 340497 4 YONIF 623 50,000 HYOSUNG SSI BJB
69 350671 4 RUMAH SAKIT MAWAR 50,000 HYOSUNG SSI BJB
70 350668 4 KANTOR DEP. AGAMA 50,000 HYOSUNG SSI BJB
71 340496 4 BJB GREENMART 50,000 HYOSUNG SSI BJB
72 340495 4 KAFE LUKAH 50,000 HYOSUNG SSI BJB
73 350670 4 BALAI DIKLAT KEAGAMAAN 50,000 HYOSUNG SSI BJB
74 340498 4 KEVIN RESORT 2 50,000 HYOSUNG SSI BJB
75 350669 4 AUTO SPEED 50,000 HYOSUNG SSI BJB
76 350672 4 GALERI ATM FIF 50,000 HYOSUNG SSI BJB
450631 4 HOTEL JELITA BANDARA 50,000 HYOSUNG SSI BJB
450858 4 HOTEL NOVOTEL BJB 50,000 HYOSUNG SSI BJB
450859 4 AKBID BINA HUSADA 50,000 HYOSUNG SSI BJB
450632 4 CHARIN QMALL 50,000 HYOSUNG SSI BJB
450860 4 TAHU SUMEDANG 50,000 HYOSUNG SSI BJB
450861 4 KANDEPAG BJB 50,000 HYOSUNG SSI BJB
450862 4 PLN UIP IX 50,000 HYOSUNG SSI BJB
 2,000
2,500
Catridge-1 Catridge-2 Catridge-3 Catridge-4 Total
WIL
Value Value Value Value Value

BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000

BRI BJM 200,000,000 200,000,000 200,000,000 200,000,000 800,000,000
BRI BJM 200,000,000 200,000,000 200,000,000 200,000,000 800,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 200,000,000 200,000,000 200,000,000 200,000,000 800,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 200,000,000 200,000,000 200,000,000 200,000,000 800,000,000
BRI BJM 100,000,000 100,000,000 200,000,000
BRI BJM 200,000,000 200,000,000 200,000,000 200,000,000 800,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 200,000,000 200,000,000 200,000,000 200,000,000 800,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
BRI BJM 100,000,000 100,000,000 100,000,000 100,000,000 400,000,000
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 DAILY RECONCILIATION REPORT
: 20/04/2016
No LOKASI JAM Bill Remain KASSET 1 KASSET 2 KASSET 3 KASSET 4 DM DIVERT TOTAL KET
1 #N/A 0:00 - -
2 #N/A 0:00 - -
3 #N/A 0:00 - -
4 #N/A 0:00 - -
5 #N/A 0:00 - -
6 #N/A 0:00 - -
7 #N/A 0:00 - -
8 #N/A 0:00 - -
9 #N/A 0:00 - -
10 #N/A 0:00 - -
11
12
13 #N/A 0:00 - -
14 #N/A 0:00 - -
15 #N/A 0:00 - -
16 #N/A 0:00 - -
17 #N/A 0:00 - -
 TANGGAL : 20/04/2016
ssi:
YG DIISI KOLOM YG
VALUE CREW BILL REMAIN Keterangan
No ATM LOCATIONMERAH AJA….KOLOM
RECORD JAM TOTAL VALUE NO. POL VALUE DENOM CASSETTE 1 CASSETTE 2 CASSETTE 3 CASSETTE 4 TOTAL ISI KASET REJECT TOTAL SK/SL
CASSETTE 1 CASSETTE 2 CASSETTE 3 CASSETTE 4 1 2 bill remain bill x denom remain x denm Pengisian
LAIN UDH RUMUS
1 #N/A - - - - - - 50,000 - - - - - ONLINE
2 #N/A - - - - - - 50,000 - - - - - ONLINE
3 #N/A - - - - - - 50,000 - - - - - ONLINE
4 #N/A - - - - - - 50,000 - - - - - ONLINE
5 #N/A - - - - - - 50,000 - - - - - ONLINE
6 #N/A - - - - - - 50,000 - - - - - ONLINE
7 #N/A - - - - - - 50,000 - - - - - ONLINE
8 #N/A - - - - - - 50,000 - - - - - ONLINE
9 #N/A - - - - - - 50,000 - - - - - ONLINE
10 #N/A - - - - - - 50,000 - - - - - ONLINE

No VALUE CREW BILL REMAIN Keterangan

ATM LOCATION RECORD JAM TOTAL VALUE NO. POL VALUE DENOM CASSETTE 1 CASSETTE 2 CASSETTE 3 CASSETTE 4 TOTAL ISI KASET REJECT TOTAL SK/SL
CASSETTE 1 CASSETTE 2 CASSETTE 3 CASSETTE 4 1 2 bill remain bill x denom remain x denm Pengisian
1 #N/A - - - - - - 100,000 - - - - - ONLINE
2 #N/A - - - - - - 100,000 - - - - - ONLINE
3 #N/A - - - - - - 100,000 - - - - - ONLINE
4 #N/A - - - - - - 100,000 - - - - - ONLINE
5 #N/A - - - - - - 100,000 - - - - - ONLINE

Dibuat, Disetujui,

MUJAHIDAH RAHMATULLAH
Admin Kas Manager

S
 DAILY REPLENISMENT SCHEDULE
Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk
Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016

DENOM 50.000,-
ATM VALUE CREW
NO TERM LOCATION TIME DENOM TOTAL VALUE NO. POL
ID CASSETTE 1 CASSETTE 2 CASSETTE 3 CASSETTE 4 1 2
1 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
2 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
3 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
4 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
5 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
6 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
7 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
8 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
9 0 #N/A 0:00 50,000 - - - - - 0 0 0 0
10 0 #N/A 0:00 50,000 - - - - - 0 0 0 0

SUB TOTAL - - - - -

DENOM 100.000,-
ATM VALUE CREW
NO TERM LOCATION TIME DENOM TOTAL VALUE NO. POL
ID CASSETTE 1 CASSETTE 2 CASSETTE 3 CASSETTE 4 1 2
1 0 #N/A 0:00 100,000 - - - - - 0 0 0 0
2 0 #N/A 0:00 100,000 - - - - - 0 0 0 0
3 0 #N/A 0:00 100,000 - - - - - 0 0 0 0
4 0 #N/A 0:00 100,000 - - - - - 0 0 0 0
5 0 #N/A 0:00 100,000 - - - - - 0 0 0 0

SUB TOTAL - - - - -
TOTAL RESTOCKING - - - - -

SIGNER CHECKER MAKER

RAHMATULLAH RAHMATULLAH MUJAHIDAH

 ACTUAL CASH COUNTED RETURN CASSETTE

Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk

Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016

DENOM 50.000,-
ATM CASSETTE Cash Counted
NO Term LOCATION VALUE DENOM Reject (%) Return
1 2 3 4 Return
ID
1 0 #N/A - 50,000 - - - - - - #DIV/0!
2 0 #N/A - 50,000 - - - - - - #DIV/0!
3 0 #N/A - 50,000 - - - - - - #DIV/0!
4 0 #N/A - 50,000 - - - - - - #DIV/0!
5 0 #N/A - 50,000 - - - - - - #DIV/0!
6 0 #N/A - 50,000 - - - - - - #DIV/0!
7 0 #N/A - 50,000 - - - - - - #DIV/0!
8 0 #N/A - 50,000 - - - - - - #DIV/0!
9 0 #N/A - 50,000 - - - - - - #DIV/0!
10 0 #N/A - 50,000 - - - - - - #DIV/0!

SUB TOTAL - - - - - - - #DIV/0!

DENOM 100.000,-
ATM CASSETTE Cash Counted
NO Term LOCATION VALUE DENOM Reject (%) Return
1 2 3 4 Return
ID
1 0 #N/A - 100,000 - - - - - - #DIV/0!
2 0 #N/A - 100,000 - - - - - - #DIV/0!
3 0 #N/A - 100,000 - - - - - - #DIV/0!
4 0 #N/A - 100,000 - - - - - - #DIV/0!
5 0 #N/A - 100,000 - - - - - - #DIV/0!

SUB TOTAL - - - - - - - #DIV/0!

TOTAL - - - - - - - #DIV/0!

SIGNER CHECKER MAKER

RAHMATULLAH RAHMATULLAH MUJAHIDAH

 DAILY RECONCILIATION REPORT
Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk
Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016

DENOM 50.000,-
CASH DISPENSED BASED ON BILL
ATM & REMAIN ACTUAL CASH CC AGAINST
NO LOCATION VALUE TIME REMARKS
Term ID COUNTED ( CC ) BILL & REMAIN
BILL REMAIN
1 0 #N/A - 0:00 - - - - COCOK
2 0 #N/A - 0:00 - - - - COCOK
3 0 #N/A - 0:00 - - - - COCOK
4 0 #N/A - 0:00 - - - - COCOK
5 0 #N/A - 0:00 - - - - COCOK
6 0 #N/A - 0:00 - - - - COCOK
7 0 #N/A - 0:00 - - - - COCOK
8 0 #N/A - 0:00 - - - - COCOK
9 0 #N/A - 0:00 - - - - COCOK
10 0 #N/A - 0:00 - - - - COCOK

SUB TOTAL - - - - -

DENOM 100.000,-
CASH DISPENSED BASED ON BILL
ATM & REMAIN ACTUAL CASH CC AGAINST
NO LOCATION VALUE TIME REMARKS
Term ID COUNTED ( CC ) BILL & REMAIN
BILL REMAIN
1 0 #N/A - 0:00 - - - - COCOK
2 0 #N/A - 0:00 - - - - COCOK
3 0 #N/A - 0:00 - - - - COCOK
4 0 #N/A - 0:00 - - - - COCOK
5 0 #N/A - 0:00 - - - - COCOK

SUB TOTAL - - - - -
TOTAL - - - - -

SIGNER CHECKER MAKER

RAHMATULLAH RAHMATULLAH MUJAHIDAH

 DAILY SUMMARY REPORT BANK RAKYAT INDONESIA
PT. SWADHARMA SARANA INFORMATIKA
SENTRA OPERASI BANJARBARU

Reporting Date : 21/04/2016

Balance b/f from : 20/04/2016 Rp -

Short Cash Rp -
Counterfeit Cash Rp -
Collection date
Locations OR's Stated Amount Var. from Count Amount counted by CPC
ATM RETURN Rp -
TAMBAHAN KAS Rp -
Sub Total 0 Rp -
TOTAL Rp -
- Del ATM Replenishment : 20/04/2016 Rp -
Total Disbursement Rp -
RETURNED CASH Rp -

DENOMINATION DEPOSIT BI DELIVERY REPLENISHMENT

100,000 Rp -
50,000 Rp -
20,000 Rp -
TOTAL 0 0 Rp -

RETURNED CASH
DENOMINATION DELIVERY TODAY REPLENISHMENT TODAY NOTES DENOMINATION COINS
100,000 0 0 Rp - 0
50,000 0 0 Rp - 0
20,000 0 0 0
MIXED
OTHER ADJUSTMENT
PENDING DEPOSIT
PENDING REPLENISHMENT Rp -
PENDING DELIVERY
IN PROCESS

TOTAL 0 0 Rp - 0

MUTASI SALDO
DENOMINASI
TANGGAL URAIAN TOTAL
100,000 50,000
20/04/2016 Saldo Awal -
TAMBAHAN KAS - - -

Other Adjustment - - -

Total Saldo - - -
REPLENISHMENT - - -

Total Pengisian ATM - - -

Saldo Sub Total - - -

ATM RETURN - - -

Total ATM RETURN - - -

Disetor - - -

Saldo Akhir - - -

Prepared by MUJAHIDAH Position: Staff Admin

Checked by RAHMATULLAH Position: Manger . Sentra Operasi

Approved by RAHMATULLAH Position: Manger . Sentra Operasi

 BERITA ACARA
SERAH TERIMA KARTU ATM TERTELAN
Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk
Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016
Prihal : Berita Acara Serah Terima Kartu ATM

NAMA
NO NAMA NO KARTU JENIS KARTU ID-ATM LOKASI KET
PETUGAS
1 #N/A Replenisment
2 #N/A Replenisment
3 #N/A Replenisment
4 #N/A Replenisment
5 #N/A Replenisment

Yang Menerima Yang Menyerahkan

PT. Bank BRI (Persero) Tbk PT. Swadharma Sarana Informatika

( ___________________________ ) MUJAHIDAH RAHMATULLAH

Admin Kas Manager
 BERITA ACARA
SERAH TERIMA ELEKTRONIK JOURNAL

Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk

Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016
Prihal : Berita Acara Serah Terima Elektronik Jurnal dan Journal Rol.

DENOM 50.000,-
PETUGAS
NO ID-ATM Merk Mesin LOKASI ELEKTRONIK JOURNAL KONDISI
RESTOCKING
1 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
2 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
3 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
4 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
5 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
6 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
7 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
8 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
9 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
10 0 #N/A #N/A 0 Data tgl s/d 20/04/2016

DENOM 100.000,-
PETUGAS
NO ID-ATM Merk Mesin LOKASI ELEKTRONIK JOURNAL KONDISI
RESTOCKING
1 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
2 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
3 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
4 0 #N/A #N/A 0 Data tgl s/d 20/04/2016
5 0 #N/A #N/A 0 Data tgl s/d 20/04/2016

Yang Menerima Yang Menyerahkan

PT. Bank BRI (Persero) Tbk PT. Swadharma Sarana Informatika

( ___________________________ ) MUJAHIDAH RAHMATULLAH

Admin Kas Manager
Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk
Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016
Prihal : Berita Acara Serah Terima Replenishment

BERITA ACARA
SERAH TERIMA LAPORAN REPLENISHMENT

NO JENIS LAPORAN LBR KET

1 DAILY REPLENISHMENT SCHEDULE 1 ADA

2 DAILY ACTUAL CASH COUNTED 1 ADA

3 DAILY RECONCILIATION REPORT 1 ADA

4 DAILY SUMMARY REPORT 1 ADA

5 BERITA ACARA SERAH TERIMA KARTU 1 ADA

6 BERITA ACARA SERAH TERIMA EJ 1 ADA

7 BERITA ACARA SELISIH - -

Yang Menerima Yang Menyerahkan

PT. Bank BRI (Persero) Tbk PT. Swadharma Sarana Informatika

( ___________________________ ) MUJAHIDAH
Admin Kas
PT. SWADHARMA SARANA INFORMATIKA

Fax kepada Klien : Kanwil BRI Banjarmasin Bagian OJL

Nomor Fax : (0511) 3252992
Attn : Bp. Fachrudin

BERITA ACARA
Laporan Selisih/Counterfeit/Unfit/Retained Card
Nomor : 0006 tanggal : 20/04/2016

Currency: IDR/Foreign SSI BANJARMASIN

Tanggal di OR 01/04/2016 Custody *Nama petugas*

Tanggal Pembukaan 20/04/2016 14:16
Client BRI Lokasi
Jenis Pengambilan

Problem Jumlah PCS Denom Total Asal Variance

Surplus DIVERTED ATM
Counterfeit
Unfit
Retained Card

OR No. -

Label No. Seal No.

Kondisi Seal BAIK Kondisi Kanvas/ TE Bag

Perincian Denom Nomor Seri

1.
2.
3.

Area
Searching Kasir

Keterangan: : Ditemukan pada saat…Penghitungan Sisa Restocking….

Masalah ditemukan
RIBHAN ADIT
( Kasir 1 ) ( Kasir 2 )

Diketahui Oleh:
MUJAHIDAH RAHMATULLAH
( Admin Kas ) Manager

Fax kepada Klien

( Pengirim ) Jam/Tgl Fax

 PT. BANK RAKYAT INDONESIA (PERSERO) Tbk,
KANTOR WILAYAH
Jl. A. Yani Km 3,5 No. 151 Banjarmasin
Telepon : (0511) 3252056, 3257057, 3251647, 3251649 Fax : (0511) 3252992

Kepada : PT. SSI BANJARMASIN

Up : Balok Suprayogi
Fax : (0511) 3260354
Dari : Kanwil BRI Banjarmasin Bagian OJL
Tanggal : 01 Januari 2013

DATA PERMINTAAN COLLECTION

TGL. PERMINTAAN : Tanggal Pelaksanaan Collection
No. B. 7395/KW-X/OJL/10/2013

DENOMINASI
UNIT BRANCH TGL TOTAL
No. NOTES COINS
KERJA CODE PENGAMBILAN PENGAMBILAN
100,000 50,000 20,000 10,000 5,000 1,000 500 1,000 500 200 100
1 SSI 9835 6/2/2013 40,000 40,000

TOTAL TAMBAHAN KAS 4,000,000,000 2,000,000,000 6,000,000,000

(ENAM MILYARD RUPIAH)

PT. BANK RAKYAT INDONESIA (PERSERO), Tbk

DIVISI SENTRA OPERASI

Heru Setiabudi Arief Bandung W Ichwan Djuari

Wapinwil Wakabag Supervisor
 BERITA ACARA PENDING ADMIN
Kepada : PT. Bank Rakyat Indonesia (Persero), Tbk
Up : Bp. Fachrudin
Facs : (0511) 3252992
Dari : PT SSI BANJARBARU
Tanggal : 20/04/2016
Prihal : Berita Acara Pending Admin

KONFIRMASI PETUGAS
NO ID-ATM LOKASI KET
PT SSI BANK BRI
1 #N/A -

Yang Menerima Yang Menyerahkan

PT. Bank BRI (Persero) Tbk PT. Swadharma Sarana Informatika

( ___________________________ ) MUJAHIDAH RAHMATULLAH

Admin Kas Manager