‘STATEMENT
PT PANEN ANTARA TAMA JASA TOUR & TRAVEL,
Setabudl 2 Buling2nd Floor LHR Rasura sad Kav. 62 Jakarta
Ph +6221 289 6090] Fax 02-21 258 7777
LTO. PTDARYAWARIALABORATORIA TK Wo serpin sat
Singur saa Dire car et
See econ
meno
\90cr-21 2Nor21 77800000 77,800.00 213,00000 2.70000 77,000.00 1,098,500.00_
——— nents
PANEMTOG 2
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ae Ae coon songPANEN TOUR
PT. PANEN ANTARA TAMA JASA BIRO PERJALANAN WISATA
‘OPERATION LICENCE NO . 94/D-2/BPUIV/79
HEAD OFFICE ;
F[o0008s ) Phn: 02122768000 7
DARYA-VARIA LABORATORIA TBK
SOUTH QUARTER TOWER C, LANTAI
18-19 JALAN R. A KARTINI KAV. 8
“J. Suryopranoto No. 49 Jakarta 10160 Indonesia JAKARTA — INVOICE JAKARTA
PusaT HOWV21100733 C/O: RAYVPO 00007503 J
Phone : (62) 3855288 Fax : (62) 3863335
Email: panentourgpanentour.com
NPWP : 01.308.793.0-028.000
‘Customer Reference (CR)
PO/LG Number :
DESCRIPTION
‘AMOUNT
SULISTYOWATIT OG 000 0513 201 G1527_— TDR 7,068 800.00
19/10 SUB UPG SUB CGIJHN 250ct21
Transaction Fee OR 27,000.00
"Exchange rate used as date of payment (i ukar mala uang yang dpergunaian Total 1OR 1,095 800.00
‘agalan yang beau pad saat pombayaran)
2Cheque should te crossed and madi payabio to PT. PANEN ANTARA TAMA ASA VAT/PPN IDR 2.70000