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  • Edy Wiyatno 2

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    Wisnu Hadi Indarmawan
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    1. This is a debit note from PT BRI Asuransi Indonesia to BRI Cabang Pacitan for policy number 1117010121001099. 2. The debit note is for IDR 233,277 for the premium, policy cost, duty cost, and total amount owed. 3. PT BRI Asuransi Indonesia requests that BRI Cabang Pacitan pays the amount due via their collectors or credits their bank account.

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    Original Title

    EDY WIYATNO 2

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    1. This is a debit note from PT BRI Asuransi Indonesia to BRI Cabang Pacitan for policy number 1117010121001099. 2. The debit note is for IDR 233,277 for the premium, policy cost, duty cost, and total amount owed. 3. PT BRI Asuransi Indonesia requests that BRI Cabang Pacitan pays the amount due via their collectors or credits their bank account.

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    © All Rights Reserved
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    10 views1 page

    Edy Wiyatno 2

    Uploaded by

    Wisnu Hadi Indarmawan
    1. This is a debit note from PT BRI Asuransi Indonesia to BRI Cabang Pacitan for policy number 1117010121001099. 2. The debit note is for IDR 233,277 for the premium, policy cost, duty cost, and total amount owed. 3. PT BRI Asuransi Indonesia requests that BRI Cabang Pacitan pays the amount due via their collectors or credits their bank account.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    AHEEEHAPPKFAJJAGIPNJGENOMAABBDCIJOPIGPAHEEEHA

    BNFFFNBPJKECAOBKFPNKAHFHAKICFHFHAGEHEPBNFFFNB
    FJIALGFIBJEMOKPIOHEJFBFBGNGPDHNCLONMGAOCJMNOI
    ABAENLFCHPNJMLDFPDCJJAJDMCPOACPMAEDOPLEEGJPJK
    EAEDLKFKHHNKFJBPMDFOJGMFNNLBKIPEAPOANHLHPFHIF
    MPJJAHFHAPGEBCDHIFCLAHFHACMHCONIPIFPAHFHAGNDJ
    EIMJFFFEDPGPHDDMIDOLBAFFDDNAHOPCEHLHBAHGBBPFD
    DBKPGKFMHBGDMONGGFADLGMIJPBADEHNGPPJIPMCENFNJ
    HGKGMHFHGGMKFPFNNJAIDMAJHPPNFGPDNHNAOCFCOJHLB
    ENNFFNEHKMMFJAEDDIBHAHFHALKGCENKDBCPAHFHAFNBH
    APBBBPAPLFHNJCFFGFBFBHBGHLLGOKOJCGHEEGDAFFNJF
    HHHHHHHPHHPPPHHPPPPHPHPPHPHPHHHHPHHPPPHPHPPHP

    NOTA DEBET / DEBET NOTE


    Kepada Yth. Nomor Nota Debet : 117/DN/01/21/016075
    To Debit Note
    Number
    BRI CABANG PACITAN Nomor Polis : 1117010121001099
    Jl. Jend. A. Yani No. 18, Pacitan Policy Number

    Ex, Polis No. :


    Original Policy
    Nama : PT BRI PACITAN QQ EDY WIYATNO
    Tertanggung
    The Insured
    Harga : IDR 97,800,000.00 Jenis Asuransi : PSAKI
    Pertanggungan Class of Business
    Sum Insured
    Periode Asuransi : 23/12/2020 - 23/12/2022 Kode Produser :
    Period of Code of Product
    Insurance
    Sumber Bisnis : Bank Nomor Nota :
    Source of Note Number
    Business
    Uraian / Remarks Jumlah / Amount Uraian / Remarks Jumlah / Amount

    11 7 / D N / 0 1 / 2 1 / 0 1 6Premi IDR 183,277.20


    075 Premium
    Premi Netto IDR 183,277.20
    Net Premium
    Biaya Polis IDR 44,000.00
    Policy Cost
    Biaya Materai IDR 6,000.00
    Duty Cost
    +/- IDR (0.20)
    Jumlah IDR 233,277.00
    Total

    Untuk PT. BRI ASURANSI IDR 233,277.00


    INDONESIA Harap Dibayar per
    kas melalui juru tagih kami /
    Mohon dikreditkan pada rekening
    giro No. 0051-01-001519-30-8
    BRI CABANG MALANG KAWI
    PENAMPUNGAN PREMI
    Premium shall be payable in the following Installment :

    Disetujui / Approval : MALANG, 11 January 2021


    AHEEEHAPMHLBAKPHNPCPHOKPMPNAGBFPHPAHEEEHA
    BNFFFNBPACMHIHFOMPIGJOIGEPFLNLAGJPBNFFFNB
    PT. BRI ASURANSI INDONESIA
    BPCDGHFOKHHGJNNHIJPLNOFLEHLEFBHLFJHHCFHOP
    DEJHMOFNMCHNPBLEFHHEKOFPKHKDKFEOMMPHIEDFK
    NGONEEFHDAHEBOFLDIKDNIOPFIFIDPNDOEIEKPFKC
    OFPANHFIAJEMGADNKPIKHEJLMLGFEPFKHDJJBAFEL
    NHLAPFFAFMILEEPKCHJKBIFPPFLMHHFLHOPHKNPBD
    PAHKMCFLNEGPPKOHDHGPFIPEFFKAFFEOKJPOIABAC
    MFNNFNEPCKPONAIJOPNPBHBHOPGENIKCAHFHAPHHL
    APBBBPAPBOJJGPEHCKGLHEGDALKNPPIOGCFCEEDOP
    HHHHHHHPHHPPHHPPHHPPPPHPHPPHHHHPPHPPHHPPP

    Jaka Panuwun

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