FORMULIR (FORM)

PERMINTAAN PENGELUARAN DANA (PPD) PT Laskar Semesta Alam

FUND REQUEST (FR)
PPD No. : 186/LSA/GA-PRG/PPD/VII/2023 Date : 29-Jul-23

Location : Jakarta x Site Office

Transaction 8-Aug-23
Status : x Budget Unbudget Curr : IDR
Date :

No Budget Code Description CC Amount

1 Pemasangan dan pembayaran indihome mess drilling Rp 769.500

TOTAL 769.500

Full Payment x Cash Advance Est Declaration: Supplier :

Payment Method Bank Received : BANK SITE

Cash Account No. :

Transfer Account Name :

Requested by, Acknowledge by, Approved by, Special Approval, Received by,

Digitally signed by
Novika Puspita
Lintangsari
Date: 2023.07.29
08:50:10 +08'00'

Name : NPL Name : BRL Name : THR Name : Name : Name : Name :
Date : Date : 31-07-2023 Date : Date : Date : Date : Date :

Form : Page 1/1