Formulir 2a PU

BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

22098940 SURYA SAPUTRA SENTOSA SURYA SAPUTRA SENTOSA 09 2023

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP Iuran JKP
Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Pemberi Kerja Tenaga Kerja Pemberi Kerja Tenaga Kerja Pemberi Kerja Pemerintah Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.)
1 23056648746 7401042903940002 C039789 ABDI PAT ADZAN 29-03-1994 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
2 22141175574 7401015110970001 ADINDA OKLADITA 11-10-1997 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
3 22160849059 7401072708020002 AGUSTIKA SAPUTRA YUSUF 27-08-2002 01-12-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
4 23056648910 7401070808810003 AGUSTINUS. SP 08-08-1981 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
5 21088039249 7471075309930001 AHYAN SEPTIYANI NINGSI 13-09-1993 01-11-2021 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
6 23005670478 7401045002010002 ALIFA AMELIA 10-02-2001 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
7 23005670593 7406142501970001 C038634 AMRI AGUS 25-01-1997 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
8 22141175558 7401010609920002 C032348 ANDI AHMAD 06-09-1992 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
9 23056648977 7401122904980001 C038290 ANDI GUNAWAN 29-04-1998 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
10 23056648944 7408052207990001 C037415 ANDRI SAPUTRA 22-07-1999 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
11 22141175806 7401262002010002 C037380 ARDI SETIAWAN 20-02-2001 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
12 22141175798 7401071009020001 C037404 ARZHEL FEBRIANSYAH 10-09-2002 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
13 22141175657 7401070310800002 C022572 DARMAN 03-10-1980 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
14 22141175699 7316034806960002 DEBI TRISNAN 08-06-1996 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
15 23056648837 7402281803970002 C040094 DEDI SURYADI 18-03-1997 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
16 23005670510 7401121405970002 C038886 DIMAS PRADITYA 14-03-1997 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
17 23093242297 7403220107000335 ERWIN 29-06-2000 01-07-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
18 23005670577 7401072403010001 C038705 FELIX MARCELINO KALA 24-03-2001 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
19 23056648845 7401073011940001 C040033 FIRMANSYAH ISKANDAR 30-11-1994 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
20 23056648704 7401071606840001 C039803 GERHAMUDDIN 16-06-1984 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
21 23076472572 7401070209880001 C040086 GISTA SANTO PERDANA 02-09-1988 01-06-2023 3,107,299.00 0.00 54,067.00 9,321.90 114,970.06 62,145.98 0.00 0.00 0.00 0.00 240,504.94
SARIANG
22 22141175715 7307041806950001 C037510 HARIANTO 18-06-1995 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
23 23056648720 7401120904910001 C039801 HARTONO 11-06-1991 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
24 23093242289 7314060110760003 HASBY SYARIFUDDIN 01-10-1976 01-07-2023 5,000,000.00 0.00 87,000.00 15,000.00 185,000.00 100,000.00 0.00 0.00 0.00 0.00 387,000.00
25 22141175830 7401073112900005 C036858 HERMAN 05-11-1989 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
26 22141175848 7401041709870001 C037405 IRWAN 17-09-1987 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
27 22141175525 7401120905020001 C037460 IRWAN PRATOMO 09-05-2002 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
28 22141175582 7401072809960001 C037647 IRWANSYAH 28-09-1996 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
29 23076472606 7401120301930002 C2346 IVAN EDWAR 03-01-1993 01-06-2023 3,107,299.00 0.00 54,067.00 9,321.90 114,970.06 62,145.98 0.00 0.00 0.00 0.00 240,504.94
30 23005670494 7302091802760001 C038118 IWAN 18-02-1976 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
31 22141175780 7408030507760002 C036946 JONI PRATAMA 05-07-1976 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
32 23005670486 7401010203990001 C038627 JUMARDY 03-08-1995 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

22098940 SURYA SAPUTRA SENTOSA SURYA SAPUTRA SENTOSA 09 2023

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP Iuran JKP
Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Pemberi Kerja Tenaga Kerja Pemberi Kerja Tenaga Kerja Pemberi Kerja Pemerintah Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.)
33 23056648985 7401070710890001 KAMA RUDDIN 04-03-1990 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
34 22141175632 7371071010970015 KURNIAWAN JAYA 10-10-1997 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
35 23076472614 7401072912020002 C040087 LA ODE MUH SYAWAL 29-12-2001 01-06-2023 3,107,299.00 0.00 54,067.00 9,321.90 114,970.06 62,145.98 0.00 0.00 0.00 0.00 240,504.94
36 22160848986 7371090901820003 M. KAHARUDDIN NURDIN 09-01-1982 01-12-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
37 20034836401 7304030312950002 M. REZKY AGUNG SETIAWAN 03-12-1995 01-06-2020 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
38 23056648779 7401040511000002 C040034 M. YUDHA RIKSANDI 05-11-2000 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
39 22141175772 7401041103790003 C037467 MARNO ARTHA DEWA 11-03-1979 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
40 22141175756 7401121903900001 C037378 MASRI 19-03-1991 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
41 21073311017 7371101111980006 MU'ARIF YUDHA BASKARA 11-11-1998 01-10-2021 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
42 21098487891 7401071306860002 MUAMAR AZIS 13-06-1986 01-12-2021 3,107,229.38 0.00 54,065.79 9,321.69 114,967.49 62,144.59 0.00 0.00 0.00 0.00 240,499.56
43 23093242248 7471101010010003 MUAMMAR QADAFI MUHAJIR 10-10-2001 01-07-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
44 22141175624 7406031106020001 C037425 MUH RAFLI 11-06-2002 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
45 23093242271 7314062102020001 MUH. FAIZAL 21-02-2002 01-07-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
46 23093242305 7471013112970001 MUH. TASNIM 10-04-1997 01-07-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
47 22141175616 7401141707980002 C037376 MUHAMMAD ALFIAN 17-07-1998 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
48 23093242263 7471051811000001 MUHAMMAD EMILL 18-11-2000 01-07-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
SUBARKAH
49 21021204033 7371110701980002 MUHAMMAD SYAHRUL 07-01-1998 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
RAMADHAN
50 23056648787 7401042210820001 NAUFAL MU'AWIYAH 22-10-1982 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
51 22141175509 7401120512960002 C037750 NIRMAN 05-12-1996 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
52 23056648993 7324113011710001 NOVIT 30-11-1971 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
53 21067681706 7371100611900005 PAMPANG MINANGA T. 06-11-1990 01-09-2021 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
54 23056648969 7401073112810005 C038021 PARMAN 31-12-1981 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
55 22040316030 7471071808000002 PAUZAN FIRDAUS RAUF 18-08-2000 01-04-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
56 23056648878 7401070909960001 C039791 RACHMAT MAKMUR 09-09-1996 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
57 23056648902 7307042103990001 C039787 RAHMAT RAHARDI RIFAI 21-03-1999 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
58 23005670551 7401072602870001 C038511 RISWAN. HK 26-02-1987 01-01-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
59 22141175731 1211116309990002 C038531 ROSALINA SILABAN 23-09-1999 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
60 23056648688 7401121908960001 C037528 RUDIANTO 19-08-1996 01-05-2023 3,107,229.00 30,703,378.00 588,304.56 101,431.82 1,250,992.46 676,212.14 0.00 0.00 0.00 0.00 2,616,940.98
61 23005670619 7406220303930001 C037463 RUSLAN EFENDI 03-03-1994 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
62 22141175541 7401121804980002 C034582 RYONALDA LEMBA 18-04-1998 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
63 22141175640 7401012510990001 C037761 SAMUEL ONAN 25-10-1999 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
64 23005670544 7401071509910001 C038488 SANDI SEPTIANUS 15-09-1991 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

22098940 SURYA SAPUTRA SENTOSA SURYA SAPUTRA SENTOSA 09 2023

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP Iuran JKP
Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Pemberi Kerja Tenaga Kerja Pemberi Kerja Tenaga Kerja Pemberi Kerja Pemerintah Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.)
65 22141175723 7401071105890001 C037732 SARMAN 11-05-1989 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
66 23005670452 7406141007900001 SHAHIB 10-07-1990 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
67 22141175673 7401071702010001 C037466 SHAHRUL 17-02-2001 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
68 22160849018 7401047112950007 ID006-S3 ST. QORIAH 31-12-1995 01-12-2022 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
69 23076472580 7401072601960001 C040095 SUFARDIN 26-01-1996 01-06-2023 3,107,299.00 0.00 54,067.00 9,321.90 114,970.06 62,145.98 0.00 0.00 0.00 0.00 240,504.94
70 23056648886 7401071007950001 C033832 SUKRIL 10-07-1995 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
71 22141175533 7401010601930002 C037464 SUMARLIN 06-01-1993 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
72 23056648712 7401071009860004 C039788 SUMARLIN 10-09-1986 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
73 23056649009 7302092707930001 SUPRIADI FAISAL 27-07-1993 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
74 23005670569 6402060310810006 C038595 SYAIFUL 03-10-1981 01-01-2023 3,500,000.00 0.00 60,900.00 10,500.00 129,500.00 70,000.00 0.00 0.00 0.00 0.00 270,900.00
75 23056648803 7401122006000001 C039798 TRIANDI HISJUN SIANG 20-06-2000 01-05-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
76 23093242255 7171086601020001 WINDI STASYA DWIPUTRI 26-01-2002 01-07-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
77 23076472598 7307026012980001 C040093 WIWIK PURWANINGSIH 20-12-1998 01-06-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
78 23076472564 7401071503800001 C040108 YORIZAL 15-03-1980 3,107,299.00 0.00 54,067.00 9,321.90 114,970.06 62,145.98 0.00 0.00 0.00 0.00 240,504.94
79 22141175764 7401121207830004 C037406 YUNUS SONDA 12-07-1983 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
80 23005670528 7401071102720001 C038489 YUSUF SAMPE 11-02-1972 01-01-2023 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52
81 22141175814 7401071704840001 C037709 ZAFRUL NAZRAWIN 17-04-1984 01-11-2022 3,107,229.00 0.00 54,065.78 9,321.69 114,967.47 62,144.58 0.00 0.00 0.00 0.00 240,499.52

Jumlah Seluruhnya 259,077,464.38 30,703,378.00 5,042,186.00 869,342.00 10,721,890.00 5,795,616.00 0.00 0.00 0.00 0.00 22,429,034.00

Keterangan
*) Isian formulir ini dapat disampaikan kepada BPJS Ketenagakerjaan dalam bentuk media elektronik (softcopy) ataupun hasil cetakan dari sistem
penggajian perusahaan peserta yang bersangkutan, dengan aturan / format yang sesuai dengan ketentuan BPJS Ketenagakerjaan

, 14 Oktober 2023

(Nama dan Tanda Tangan Pimpinan Perusahaan)

Jabatan :