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___FORMUUIR KLAIM ; *)BCA ____{Betisin/Solar, Parkit, Tol, Osb) ‘BA. re Naina WUSC I, Totti BAA mee sents Kendoroad +... wou Nepal: YD YE33 We. gna (as) re 7145008200856603 lomnater Awa { Pada saat ¢kan Yaranghat ) SEMI oa. ws aut [creer kt (pad sat nob sap tater) Eb Se rk fe i a Rina maa te \|[Pr ss Wand, Bes ose ess bosons Biaye: {. Bentin/Soter 2. Biaya Tot Batis renee GATE 8 68:2 a.pedar shaston tor dst) 3 nist nasest ‘tucson Ast, OATES wm suse unr eetbde GEE MEE ay OE * Total : Rp. 2 N90 2. ons. Inetensi deandetonger Se TT a ‘Menoger), resco tooENNNSTS ‘em 600) Le aie Ena 2 cannae ene ro item Ween ceo Me 2 Me oma wan yeas a cee ae ‘tes serene ome Spe (Naina, 14! 8770) (Naina, T4&T1D) (tama, Tg& TTD) ge ewe Mon Mandger d fee meme wee toe nets es eA pet, weg nt tn Vin ie ny pa sri de pacenceta tela tatacctacgewacmaniecnee memes eM TST wisi Sct tencrn oe dsangvengm fang tne ata nba a wom" uo wen hee sagan or Reus Gp sasamarcn Gp insane - oe n3: fo 30 7 org, nem Yall gigs wc, on Al é Pic El 7/03/2022 10:14:01 04/01/01 no Seri: 17990 191099/85054 | Toll Bk Ap 000 YRZ00550093 Ro, 169500 PT-Selamar Sempurna PT-Selamat Sempurna B (133 PYC Nl (9) JASAMARGA wi Tat? © tows iauk PT Selamat Sempurna Trower. 0:30:46 15M fo seri :6t4aH0 0058151600 Get Tol Al Coe sn8z00856698 Re, 17800 b&b 1722 WO Dal igs te Dal AJASAMAARG! ‘wi Tot” &) 18008 Info Tol : @ 14080 CIBATU Selamat Sepa 5 08:48:31 Ot ‘ontay2ne2 21:30:87 04/03/03 No seri 107698 200409/ 152488 ‘No seri Py 2004091132143 GOL ell hold GO| ell hota [NO SRSA Re. BSID PT -Selamat Sempuma © (02249 ow $ SPBU 34.17510 ‘U1.Lippo City Cikarar BCA a ei ON HA Rc SN BIBS PIC La WL Senin, 07 Haret 2022 08:54:20 ‘PPD CKARMHG,REVAST Tey E2463) ‘ERcy otwesosoT4ss6 No. Nota 01.01.50214 fur at) Jenis BBM 3 Partalite (@t4s008200556683 Harga/liter 1 Rp. 7.680 x. (WTEATONE 7 M22 O85 Liter : 19,600 ACH = 000890 TAGE MM: O02 5 1 FsE67M ron 38771 Total Rye ‘sto {TOTAL Rp. 150,000 eas a Tuna Rp. 150.000 ag Se at oe OS t CTU Pelanggan ‘Terinakasih dan Gelawat jalan

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