Kepada Yth / To No.

Rekening/Account Number : 178-00-0342964-0

17800 Nama Produk/Product Nama : MANDIRI TAB PAYROLL
ARIEF BAKHTIAR LUTFI Valuta/Currency : Indonesia Rupiah
JL KH KHOLIL GG 17-A NO 4 Periode/Period : 01/07/23 s/d 27/12/23
RT 006 RW 001 Cabang/Branch : KC Gresik Kartini
Kebungson GRESIK 61115 No. Kartu/Card Number : 0032988662033393
No. NPWP/NPWP Number : -

8662033393

HALAMAN: 1

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

05/07 Saldo Pemindahan 55,651.00

05/07 05/07 MOM InhouseTrf - 479601654-178000342 30,000.00 55,651.00
05/07 05/07 MOM InhouseTrf - 479601654-178000342 20,000.00 75,651.00
05/07 05/07 Tarif Link - 01005994 /0085852009/ATB-0000000000920 50,000.00 D 25,651.00
05/07 05/07 Tarif Link - 01005994 /0085852009/ATB-0000000000920 7,500.00 D 18,151.00
06/07 06/07 MOM InhouseTrf - GAJI PT KSS 9,168,367.00 9,186,518.00
06/07 06/07 - 20231106BMRIIDJA01000221130821 6,000,000.00 D 2,186,519.00
06/07 06/07 - 20231106BMRIIDJA01000221130821 2,500.00 D 2,184,018.00
06/07 06/07 MOM InhouseTrf - 100,000.00 D 2,084,018.00
06/07 06/07 - 77819616 /0000523619/VAP- 26,500.00 D 2,057,518.00
06/07 06/07 - 74833164 /0000546865/VAP- 408,912.00 D 1,648,606.00
06/07 06/07 Tarik ATM - S1AWKD0I /6848732994/ATM-POOLSUDIRMA 300,000.00 D 1,348,606.00
06/07 06/07 - UBP60148960801FFFFFF896081515613450 151,020.00 D 1,197,586.00
07/07 07/07 - UBP60148930801FFFFFF893081515613450 51,000.00 D 1,140,586.00
08/07 08/07 Tarik ATM - S1AW1NTO /7884489032/ATM-KPTDARMOSGN 300,000.00 D 846,586.00
08/07 08/07 - 20231108DANAIDJ101009978015549 100,000.00 946,586.00
08/07 08/07 - 20231108OENAIDJA01000259396605 12,000.00 958,586.00
08/07 08/07 - 150,000.00 1,108,586.00
09/07 09/07 - UBP60148930801FFFFFF893081515613450 101,000.00 D 1,007,586.00
09/07 09/07 - 20231108OENAIDJA0100262294658 100,000.00 1,107,586.00
09/07 09/07 MOM InhouseTrf - 150,000.00 1,257,586.00
10/07 10/07 - S1RHKNOC /7848671972/ATM-OB MMUPASAR 600,000.00 D 657,586.00
10/07 10/07 - UBP60148930801FFFFFF893081515613450 131,000.00 D 526,586.00
10/07 10/07 - 20231110BRINDJA01000281719191 150,000.00 676,586.00
11/07 11/07 - UBP60148960801FFFFFF896081515613450 124,000.00 D 552,586.00
11/07 11/07 Tarik ATM - S1AW1DTO /6884482407/ATM-KAPTENDULHA 300,000.00 D 252,586.00
12/07 12/07 - UBP60148890891FFFFFF8890831134098342 1 42,737.00 D 109,849.00
Kepada Yth / To No. Rekening/Account Number : 178-00-0342964-0
17800 Nama Produk/Product Nama : MANDIRI TAB PAYROLL
ARIEF BAKHTIAR LUTFI Valuta/Currency : Indonesia Rupiah
JL KH KHOLIL GG 17-A NO 4 Periode/Period : 01/07/23 s/d 27/12/23
RT 006 RW 001 Cabang/Branch : KC Gresik Kartini
Kebungson GRESIK 61115 No. Kartu/Card Number : 0032988662033393
No. NPWP/NPWP Number : -

8662033393

HALAMAN: 2

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

12/07 Saldo Pemindahan 259,849.00

14/07 14/07 - 20231114DANAIDJ101009937878892 150,000.00 259,849.00
15/07 15/07 MOM InhouseTrf - wifi bulan juli 2023 150,000.00 409,849.00
15/07 15/07 - S1ITPKA012/6951 /LMP-99000000009/G1 350,000.00 D 59,849.00
15/07 15/07 - 20231115OENAIDJA01000286505868 150,000.00 209.849.00
16/07 16/07 Tarik ATM - S1AW1DTO /6884483300/ATM-KAPTENDULHA 150,000.00 D 59,849.00
19/07 19/07 - 20231119OENAIDJA01000297437053 150,000.00 209,849.00
19/07 19/07 - 20231119BMRIIDJA01000220642334 150,000.00 D 59,849.00
19/07 19/07 - 20231119BMRIIDJA01000220642334 2,500.00 D 57,349.00
19/07 19/07 - 20231119DANAIDJ101009984292741 150,000.00 207,349.00
20/07 20/07 MOM InhouseTrf - 150,000.00 357,349.00
20/07 20/07 - UBP60148930801FFFFFF893081515613450 51,000.00 D 306,349.00
20/07 20/07 MOM InhouseTrf - 150,000.00 456,349.00
21/07 21/07 MOM InhouseTrf - wifi juli user 22 96 300,000.00 756,349.00
21/07 21/07 Tarif Link - 01005994 /0089994545/ATB-0000000000920 50,000.00 D 706,349.00
21/07 21/07 Tarif Link - 01005994 /0089994545/ATB-0000000000920 7,500.00 D 698,849.00
21/07 21/07 Tarif Link - 01005994 /0089994796/ATB-0000000000920 100,000.00 D 598,849.00
21/07 21/07 Tarif Link - 01005994 /0089994796/ATB-0000000000920 7,500.00 D 591,349.00
21/07 21/07 - 20231121BMRIIDJA01000221424292 300,000.00 D 291,349.00
21/07 21/07 - 20231121BMRIIDJA01000221424292 2,500.00 D 288,849.00
22/07 22/07 - 20231122BNINIDJA01000299770634 75,000.00 363,849.00
22/07 22/07 Tarik ATM - S1AW1NT0 /7884481923/ATM-KPTDARMOSGN 100,000.00 D 263,849.00
22/07 22/07 MOM InhouseTrf - DANA001015612212249 200,000.00 463,849.00
22/07 22/07 - MONTHLY CARD CHARGE 0006032988662033393 3,500.00 D 460,349.00
23/07 23/07 - 20231123BRINIDJA01000231716198 150,000.00 610,349.00
23/07 23/07 - 75851912 /0000528874/VAP- 329,494.00 D 280,855.00
24/07 24/07 - UBP60148930801FFFFFF893081515613450 53,000.00 D 227,855.00
24/07 24/07 - 20231124OENAIDJA01000208954468 150,000.00 377,855.00
24/07 24/07 - 20231124BMRIIDJA01000222684888 80,000.00 D 297,855.00
24/07 24/07 - 20231124BMRIIDJA01000222684888 2,500.00 D 295,355.00
25/07 25/07 Tarik ATM - S1AW1DTO /6884485385/ATM-KAPTENDULHA 250,000.00 D 45,355.00
Kepada Yth / To No. Rekening/Account Number : 178-00-0342964-0
17800 Nama Produk/Product Nama : MANDIRI TAB PAYROLL
ARIEF BAKHTIAR LUTFI Valuta/Currency : Indonesia Rupiah
JL KH KHOLIL GG 17-A NO 4 Periode/Period : 01/07/23 s/d 27/12/23
RT 006 RW 001 Cabang/Branch : KC Gresik Kartini
Kebungson GRESIK 61115 No. Kartu/Card Number : 0032988662033393
No. NPWP/NPWP Number : -

8662033393

HALAMAN: 3

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

25/07 Saldo Pemindahan 125,355.00

26/07 26/07 - 20231126BNINIDJA01000204134950 80,000.00 125,355.00
26/07 26/07 - 20231126BMRIIDJA01000227411980 55,000.00 D 70,355.00
26/07 26/07 - 20231126BMRIIDJA01000227411980 2,500.00 D 67,855.00
26/07 26/07 MOM InhouseTrf - bayar wifi 150,000.00 217,855.00
26/07 26/07 Tarik ATM - S1W1DTO /6884485715/ATM-KAPTENDULHA 100,000.00 D 117,855.00
27/07 27/07 MOM InhouseTrf - 125,000.00 242,855.00
27/07 27/07 Tarik ATM - S1AW14TU /5284853782/ATM-SUNANGIRI 0 100,000.00 D 142,855.00
29/07 29/07 Tarik ATM - S1AW14TP /5284800061/ATM-POOLSUDIRMA 100,000.00 D 42,855.00
30/07 30/07 MOM InhouseTrf - SHOPEE_200001012 A170135026446077090 155,000.00 197,855.00
30/07 30/07 Biaya Adm - 6,000.00 D 191,855.00
05/08 05/08 MOM InhouseTrf - GAJI PT KSS 9,748,126.00 9,845,504.00
05/08 05/08 - 74833164 /0000590927/VAP- 73,911.00 D 9,771,593.00
05/08 05/08 - 75671736 /0000593235/VAP- 562,442.00 D 9,209,151.00
05/08 05/08 Tarik ATM - S1AW14TP /5284802520/ATM-POOLSUDIRMA 300,000.00 D 8,909,151.00
05/08 05/08 - 20231005BMRIIDJA01000220761630 8,000,000.00 D 909,151.00
05/08 05/08 - 20231005BMRIIDJA01000220761630 2,500.00 D 906,651.00
07/08 07/08 - UBP60148930801FFFFFF893081515613450 51,000.00 D 855,651.00
08/08 08/08 - S1RHA4JT /5274843509/ATM-MOLWTC 01 400,000.00 D 455,651.00
10/08 10/08 MOM InhouseTrf - 150,000.00 605,651.00
10/08 10/08 Tarik ATM - S1ANK40K /5248756972/ATM-POOLSUDIRMA 100,000.00 D 505,651.00
11/08 11/08 Tarik ATM - S1AW1DTO /6884485250/ATM-KAPTENDULHA 300,000.00 D 205,651.00
12/08 12/08 - UBP60148930801FFFFFF893081515613450 51,000.00 D 154,651.00
13/08 13/08 - 20231013BRINIDJA01000219040517 150,000.00 304,651.00
13/08 13/08 - UBP60148930801FFFFFF893081515613450 51,000.00 D 253,651.00
13/08 13/08 - 20231013BMRIIDJA01000221784103 100,000.00 D 153,651.00
13/08 13/08 - 20231013BMRIIDJA01000221784103 2,500.00 D 151,151.00
14/08 14/08 Tarik ATM - S1AWKDOI /6848730611/ATM-POOLSUDIRMA 100,000.00 D 51,151.00
15/08 15/08 - 20231015BTANIDJA01000208610163 150,000.00 201,151.00
15/08 15/08 MOM InhouseTrf - wifi agustus 2023 150,000.00 351,151.00
15/08 15/08 MOM InhouseTrf - 468353461-178000342 100,000.00 451,151.00
15/08 15/08 - 20231015DANAIDJ101009957794692 150,000.00 601,151.00
Kepada Yth / To No. Rekening/Account Number
17800 Nama Produk/Product Nama
ARIEF BAKHTIAR LUTFI Valuta/Currency
JL KH KHOLIL GG 17-A NO 4 Periode/Period
RT 006 RW 001 Cabang/Branch
Kebungson GRESIK 61115 No. Kartu/Card Number
No. NPWP/NPWP Number
: 178-00-0342964-0
: MANDIRI TAB PAYROLL
: Indonesia Rupiah
: 01/07/23 s/d 27/12/23
: KC Gresik Kartini
: 0032988662033393
: -

8662033393

HALAMAN: 4

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

15/08 Saldo Pemindahan 501,151.00

16/08 16/08 - 20231016BMRIIDJA01000221204018 100,000.00 D 501,151.00
16/08 16/08 - 20231016BMRIIDJA01000221204018 2,500.00 D 498,651.00
16/08 16/08 Tarik ATM - S1ANA41T /5249787989/ATM-GRESIKMANYA 400,000.00 D 98,651.00
17/08 17/08 MOM InhouseTrf - 150,000.00 248,651.00
17/08 17/08 Tarik ATM - S1AW1DT0 /6884486363/ATM-KAPTENDULHA 100,000.00 D 148,651.00
17/08 17/08 MOM InhouseTrf - 23AH1LN500948410 925,000.00 1,073,651.00
18/08 18/08 - UBP60148930801FFFFFF898081515613450 301,000.00 D 772,651.00
19/08 19/08 - 20231019DANAIDJ101009988082541 150,000.00 922,651.00
20/08 20/08 - 20231020OENAIDJA01000287273704 150,000.00 1,072,651.00
20/08 20/08 MOM InhouseTrf - wifi agustus user 22 98 300,000.00 1,372,651.00
20/08 20/08 MOM InhouseTrf - 150,000.00 1,522,651.00
20/08 20/08 - 20231020OENAIDJA01000289846401 150,000.00 1,672,651.00
21/08 21/08 - UBP60148930801FFFFFF893081515613450 201,000.00 D 1,471,651.00
21/08 21/08 - UBP60148930801FFFFFF893081515613450 51,000.00 D 1,420,651.00
21/08 21/08 - 20231021BMRTIDJA01000225874022 100,000.00 D 1,320,651.00
21/08 21/08 - 20231021BMRTIDJA01000225874022 2,500.00 D 1,318,151.00
21/08 21/08 - 20231021OENAIDJA01000292392056 150,000.00 1,468,151.00
21/08 21/08 MOM InhouseTrf - 150,000.00 1,616,151.00
21/08 21/08 - 20231021BRINIDJA01000227005695 150,000.00 1,768,151.00
21/08 21/08 - UBP60148804401FFFFFF880446009193470 81,000.00 D 1,687,151.00
22/08 22/08 MOM InhouseTrf - 800,000.00 D 887,151.00
22/08 22/08 Tarik ATM - S1AW1DTO /6884487405/ATM-KAPTENDULHA 300,000.00 D 587,151.00
22/08 22/08 - MONTHLY CARD CHARGE 0006032988662033393 3,500.00 D 583,651.00
23/08 23/08 MOM InhouseTrf - 52,000.00 635,651.00
23/08 23/08 - UBP60148930801FFFFFF893081515613450 51,000.00 D 584,651.00
23/08 23/08 MOM InhouseTrf - SHOPEE_200001012 A169806293562972080 150,000.00 734,651.00
25/08 25/08 Tarik ATM - S1AW1DTO /6884488090/ATM-KAPTENDULHA 100,000.00 D 634,651.00
26/08 26/08 Tarik ATM - S1AW1NT0 /7884485646/ATM-KPTDARMOSGN 300,000.00 D 334,651.00
27/08 27/08 - 20231027OENAIDJA01000215423872 150,000.00 484,651.00
28/08 28/08 - UBPS60148960801FFFFFF896081515613450 52,000.00 D 432,651.00
Kepada Yth / To No. Rekening/Account Number
17800 Nama Produk/Product Nama
ARIEF BAKHTIAR LUTFI Valuta/Currency
JL KH KHOLIL GG 17-A NO 4 Periode/Period
RT 006 RW 001 Cabang/Branch
Kebungson GRESIK 61115 No. Kartu/Card Number
No. NPWP/NPWP Number
: 178-00-0342964-0
: MANDIRI TAB PAYROLL
: Indonesia Rupiah
: 01/07/23 s/d 27/12/23
: KC Gresik Kartini
: 0032988662033393
: -

8662033393
HALAMAN: 5

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

Saldo Pemindahan 18,618.00

01/09 01/09 - 20230901BRINIDJA01000283524305 150,000.00 168,618.00
01/09 01/09 Tarik ATM - S1AW1NT0 /7884482929/ATM-KPTDARMOSGN 100,000.00 D 68,618.00
02/09 02/09 - UBP60148930801FFFFFF893081515613450 51,000.00 D 17,618.00
05/09 05/09 MOM InhouseTrf - GAJI PT KSS 9,116,089.00 9,133,707.00
05/09 05/09 - 20230905BMRIIDJA01000225548875 6,800,000.00 D 2,333,707.00
05/09 05/09 - 20230905BMRIIDJA01000225548875 2,500.00 D 2,331,207.00
05/09 05/09 - UBP60148930801FFFFFF893081515613450 101,000.00 D 2,230,207.00
06/09 06/09 - UBP60148930801FFFFFF893081515613450 251,000.00 D 1,979,207.00
07/09 07/09 - 72104395 /0000804712/VAP-INDOMARET T 279,100.00 D 1,700.107.00
08/09 08/09 - 20230908BMRIIDJA01000225442625 250,000.00 D 1,450,107.00
08/09 08/09 - 20230908BMRIIDJA01000225442625 2,500.00 D 1,447,607.00
08/09 08/09 - 72104395 /0000161239/VAP-INDOMARET T 233,100.00 D 1,214,507.00
09/09 09/09 - UBP60148930801FFFFFF893081515613450 131,000.00 D 1,083,507.00
09/09 09/09 MOM InhouseTrf - SHOPEE_200006901 A169421309703520120 140,000.00 1,223,507.00
09/09 09/09 MOM InhouseTrf - 140,000.00 D 1,083,507.00
09/09 09/09 - UBP60148960801FFFFFF896081515613450 54,200.00 D 1,029,307.00
09/09 09/09 - 309099363756 32,000.00 D 997,307.00
09/09 09/09 Tarik ATM - S1AW14TP /5284804156/ATM-POOLSUDIRMA 200,000.00 D 797,307.00
10/09 10/09 MOM InhouseTrf - 57,511.00 D 739,796.00
10/09 10/09 - 72104395 /0000021033/VAP- 154,500.00 D 585,296.00
11/09 11/09 - UBP60148960801FFFFFF896081515613450 84,905.00 D 500,391.00
11/09 11/09 Tarik ATM - S1AW1NT0 /7884485784/ATM-KPTDARMOSGN 200,000.00 D 300,391.00
11/09 11/09 MOM InhouseTrf - 51,772.00 D 246,619.00
11/09 11/09 MOM InhouseTrf - 150,000.00 398,619.00
14/09 14/09 Tarik ATM - S1AW1NT0 /7884486496/ATM-KPTDARMOSGN 200,000.00 D 198,619.00
14/09 14/09 - UBP60148960801FFFFFF896081515613450 47,555.00 D 151.064.00
14/09 14/09 Tarik ATM - S1AW14TP /5284805625/ATM-POOLSUDIRMA 50,000.00 D 101,064.00
15/09 15/09 - 150,000.00 251,064.00
15/09 15/09 - 20230915BRINIDJA01000238812386 150,000.00 401,064.00
Kepada Yth / To No. Rekening/Account Number
17800 Nama Produk/Product Nama
ARIEF BAKHTIAR LUTFI Valuta/Currency
JL KH KHOLIL GG 17-A NO 4 Periode/Period
RT 006 RW 001 Cabang/Branch
Kebungson GRESIK 61115 No. Kartu/Card Number
No. NPWP/NPWP Number
: 178-00-0342964-0
: MANDIRI TAB PAYROLL
: Indonesia Rupiah
: 01/07/23 s/d 27/12/23
: KC Gresik Kartini
: 0032988662033393
: -

8662033393
HALAMAN: 6

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

15/09 Saldo Pemindahan 294,563.00

15/09 15/09 - 74750768 /0000234156/VAP- 106,501.00 D 294,563.00
15/09 15/09 MOM InhouseTrf - wifi bulan September 2023 150,000.00 444,563.00
16/09 16/09 - 309166962263 80,135.00 D 364,428.00
16/09 16/09 MOM InhouseTrf - 300,000.00 D 64,428.00
16/09 16/09 MOM InhouseTrf - 52,000.00 116,428.00
17/09 17/09 - 20230917BMRIIDJA01000220408866 100,000.00 D 16,428.00
17/09 17/09 - 20230917BMRIIDJA01000220408866 2,500.00 D 13.928.00
18/09 18/09 - 20230918OENAIDJA01000278092563 150,000.00 163,928.00
18/09 18/09 - 20230918DANAIDJ101009980623541 150,000.00 313,928.00
19/09 19/09 MOM InhouseTrf - 150,000.00 463,928.00
19/09 19/09 - 20230919DANAIDJ101009997028392 150,000.00 613.928.00
19/09 19/09 - 20230919SYNAIDJ101000200009666 150,000.00 763,928.00
19/09 19/09 - UBP60144003501FFFFFF152420252644 2,500.00 D 761,426.00
19/09 19/09 - UBP60144003501FFFFFF152420252644 394,050.00 D 367,378.00
20/09 20/09 MOM InhouseTrf - wifi september user 22 98 300,000.00 667,378.00
20/09 20/09 MOM InhouseTrf - 150,000.00 817,378.00
20/09 20/09 MOM InhouseTrf - SHOPEE_200001012 A169520199702626890 150,000.00 967,378.00
20/09 20/09 - 20230920OENAIDJA01000287282059 150,000.00 1,117,378.00
21/09 21/09 - 20230921BMRIIDJA01000225710568 500,000.00 D 617,378.00
21/09 21/09 - 20230921BMRIIDJA01000225710568 2,500.00 D 614,878.00
21/09 21/09 - S1RHKNOC /7848673048/ATM-08 MMUPASAR 300,000.00 D 314,878.00
21/09 21/09 - 20230921OENAIDJA01000289755694 150,000.00 464,878.00
21/09 21/09 MOM InhouseTrf - 150,000.00 614.878.00
21/09 21/09 - 20230921BRINIDJA01000226357225 150,000.00 764,878.00
21/09 21/09 - 20230921OENAIDJA01000290785637 300,000.00 1,064,878.00
22/09 21/09 - 20230921BMRIIDJA01000221295999 550,000.00 D 514,878.00
22/09 21/09 - 20230921BMRIIDJA01000221295999 2,500.00 D 512,378.00
22/09 22/09 - 20230922OENAIDJA01000293914626 150,000.00 662,378.00
22/09 22/09 Tarik ATM - S1AW1DT0 /6884480793/ATM-KAPTENDULHA 300,000.00 D 362,378.00
22/09 22/09 - MONTHLY CARD CHARGE 0006032988662033393 3,500.00 D 358,878.00
Kepada Yth / To No. Rekening/Account Number
17800 Nama Produk/Product Nama
ARIEF BAKHTIAR LUTFI Valuta/Currency
JL KH KHOLIL GG 17-A NO 4 Periode/Period
RT 006 RW 001 Cabang/Branch
Kebungson GRESIK 61115 No. Kartu/Card Number
No. NPWP/NPWP Number
: 178-00-0342964-0
: MANDIRI TAB PAYROLL
: Indonesia Rupiah
: 01/07/23 s/d 27/12/23
: KC Gresik Kartini
: 0032988662033393
: -

8662033393
HALAMAN: 7

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

22/09 Saldo Pemindahan 307,878.00

23/09 23/09 - UBP60148930801FFFFFF893081515613450 51,000.00 D 307,878.00
24/09 24/09 - S1RO178H /5556727315/ATM-MM V-MART 100,000.00 D 207,878.00
26/09 26/09 - 20230926OENAIDJA01000204072596 150,000.00 357,878.00
26/09 26/09 - 20230926BMRIIDJA01000225079623 100,000.00 D 257,878.00
26/09 26/09 - 20230926BMRIIDJA01000225079623 2,500.00 D 255,378.00
27/09 27/09 - UBP60148930801FFFFFF893081515613450 51,000.00 D 204,378.00
27/09 27/09 MOM InhouseTrf - 100,000.00 304,378.00
28/09 28/09 - UBP60148930801FFFFFF893081515613450 201,000.00 D 103,378.00
30/09 30/09 Biaya Adm - 6,000.00 D 97,378.00
05/10 05/10 MOM InhouseTrf - GAJI PT KSS 9,748,126.00 9,845,504.00
05/10 05/10 - 74833164 /0000590927/VAP- 73,911.00 D 9,771,593.00
05/10 05/10 - 75671736 /0000593235/VAP- 562,442.00 D 9,209,151.00
05/10 05/10 Tarik ATM - S1AW14TP /5284802520/ATM-POOLSUDIRMA 300,000.00 D 8,909,151.00
05/10 05/10 - 20231005BMRIIDJA01000220761630 8,000,000.00 D 909,151.00
05/10 05/10 - 20231005BMRIIDJA01000220761630 2,500.00 D 906,651.00
07/10 07/10 - UBP60148930801FFFFFF893081515613450 51,000.00 D 855,651.00
08/10 08/10 - S1RHA4JT /5274843509/ATM-MOLWTC 01 400,000.00 D 455,651.00
10/10 10/10 MOM InhouseTrf - 150,000.00 605,651.00
10/10 10/10 Tarik ATM - S1ANK40K /5248756972/ATM-POOLSUDIRMA 100,000.00 D 505,651.00
11/10 11/10 Tarik ATM - S1AW1DTO /6884485250/ATM-KAPTENDULHA 300,000.00 D 205,651.00
12/10 12/10 - UBP60148930801FFFFFF893081515613450 51,000.00 D 154,651.00
13/10 13/10 - 20231013BRINIDJA01000219040517 150,000.00 304,651.00
13/10 13/10 - UBP60148930801FFFFFF893081515613450 51,000.00 D 253,651.00
13/10 13/10 - 20231013BMRIIDJA01000221784103 100,000.00 D 153,651.00
13/10 13/10 - 20231013BMRIIDJA01000221784103 2,500.00 D 151,151.00
14/10 14/10 Tarik ATM - S1AWKDOI /6848730611/ATM-POOLSUDIRMA 100,000.00 D 51,151.00
15/10 15/10 - 20231015BTANIDJA01000208610163 150,000.00 201,151.00
15/10 15/10 MOM InhouseTrf - wifi oktober 2023 150,000.00 351,151.00
15/10 15/10 MOM InhouseTrf - 468353461-178000342 100,000.00 451,151.00
15/10 15/10 - 20231015DANAIDJ101009957794692 150,000.00 601,151.00
Kepada Yth / To No. Rekening/Account Number
17800 Nama Produk/Product Nama
ARIEF BAKHTIAR LUTFI Valuta/Currency
JL KH KHOLIL GG 17-A NO 4 Periode/Period
RT 006 RW 001 Cabang/Branch
Kebungson GRESIK 61115 No. Kartu/Card Number
No. NPWP/NPWP Number
: 178-00-0342964-0
: MANDIRI TAB PAYROLL
: Indonesia Rupiah
: 01/07/23 s/d 27/12/23
: KC Gresik Kartini
: 0032988662033393
: -

8662033393

HALAMAN: 8

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

15/10 Saldo Pemindahan 501,151.00

16/10 16/10 - 20231016BMRIIDJA01000221204018 100,000.00 D 501,151.00
16/10 16/10 - 20231016BMRIIDJA01000221204018 2,500.00 D 498,651.00
16/10 16/10 Tarik ATM - S1ANA41T /5249787989/ATM-GRESIKMANYA 400,000.00 D 98,651.00
17/10 17/10 MOM InhouseTrf - 150,000.00 248,651.00
17/10 17/10 Tarik ATM - S1AW1DT0 /6884486363/ATM-KAPTENDULHA 100,000.00 D 148,651.00
17/10 17/10 MOM InhouseTrf - 23AH1LN500948410 925,000.00 1,073,651.00
18/10 18/10 - UBP60148930801FFFFFF898081515613450 301,000.00 D 772,651.00
19/10 19/10 - 20231019DANAIDJ101009988082541 150,000.00 922,651.00
20/10 20/10 - 20231020OENAIDJA01000287273704 150,000.00 1,072,651.00
20/10 20/10 MOM InhouseTrf - wifi oktober user 22 98 300,000.00 1,372,651.00
20/10 20/10 MOM InhouseTrf - 150,000.00 1,522,651.00
20/10 20/10 - 20231020OENAIDJA01000289846401 150,000.00 1,672,651.00
21/10 21/10 - UBP60148930801FFFFFF893081515613450 201,000.00 D 1,471,651.00
21/10 21/10 - UBP60148930801FFFFFF893081515613450 51,000.00 D 1,420,651.00
21/10 21/10 - 20231021BMRTIDJA01000225874022 100,000.00 D 1,320,651.00
21/10 21/10 - 20231021BMRTIDJA01000225874022 2,500.00 D 1,318,151.00
21/10 21/10 - 20231021OENAIDJA01000292392056 150,000.00 1,468,151.00
21/10 21/10 MOM InhouseTrf - 150,000.00 1,616,151.00
21/10 21/10 - 20231021BRINIDJA01000227005695 150,000.00 1,768,151.00
21/10 21/10 - UBP60148804401FFFFFF880446009193470 81,000.00 D 1,687,151.00
22/10 22/10 MOM InhouseTrf - 800,000.00 D 887,151.00
22/10 22/10 Tarik ATM - S1AW1DTO /6884487405/ATM-KAPTENDULHA 300,000.00 D 587,151.00
22/10 22/10 - MONTHLY CARD CHARGE 0006032988662033393 3,500.00 D 583,651.00
23/10 23/10 MOM InhouseTrf - 52,000.00 635,651.00
23/10 23/10 - UBP60148930801FFFFFF893081515613450 51,000.00 D 584,651.00
23/10 23/10 MOM InhouseTrf - SHOPEE_200001012 A169806293562972080 150,000.00 734,651.00
25/10 25/10 Tarik ATM - S1AW1DTO /6884488090/ATM-KAPTENDULHA 100,000.00 D 634,651.00
26/10 26/10 Tarik ATM - S1AW1NT0 /7884485646/ATM-KPTDARMOSGN 300,000.00 D 334,651.00
27/10 27/10 - 20231027OENAIDJA01000215423872 150,000.00 484,651.00
28/10 28/10 - UBPS60148960801FFFFFF896081515613450 52,000.00 D 432,651.00
Kepada Yth / To No. Rekening/Account Number
17800 Nama Produk/Product Nama
ARIEF BAKHTIAR LUTFI Valuta/Currency
JL KH KHOLIL GG 17-A NO 4 Periode/Period
RT 006 RW 001 Cabang/Branch
Kebungson GRESIK 61115 No. Kartu/Card Number
No. NPWP/NPWP Number
: 178-00-0342964-0
: MANDIRI TAB PAYROLL
: Indonesia Rupiah
: 01/07/23 s/d 27/12/23
: KC Gresik Kartini
: 0032988662033393
: -

8662033393

HALAMAN: 9

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

28/10 Saldo Pemindahan 132,651.00

28/10 28/10 Tarik ATM - S1ANK40F /5248707622/ATM-POOLSUDRIMA 300,000.00 D 132,651.00
28/10 28/10 - UBP60148930801FFFFFF893081515613450 51,000.00 D 81,651.00
30/10 30/10 Tarik ATM - S1AW1DT0 /6884489221/ATM-KAPTENDULHA 50,000.00 D 31,651.00
31/10 31/10 Biaya Adm - 6,000.00 D 25,651.00
05/11 05/11 MOM InhouseTrf - 479601654-178000342 30,000.00 55,651.00
05/11 05/11 MOM InhouseTrf - 479601654-178000342 20,000.00 75,651.00
05/11 05/11 Tarif Link - 01005994 /0085852009/ATB-0000000000920 50,000.00 D 25,651.00
05/11 05/11 Tarif Link - 01005994 /0085852009/ATB-0000000000920 7,500.00 D 18,151.00
06/11 06/11 MOM InhouseTrf - GAJI PT KSS 9,168,367.00 9,186,518.00
06/11 06/11 - 20231106BMRIIDJA01000221130821 6,000,000.00 D 2,186,519.00
06/11 06/11 - 20231106BMRIIDJA01000221130821 2,500.00 D 2,184,018.00
06/11 06/11 MOM InhouseTrf - 100,000.00 D 2,084,018.00
06/11 06/11 - 77819616 /0000523619/VAP- 26,500.00 D 2,057,518.00
06/11 06/11 - 74833164 /0000546865/VAP- 408,912.00 D 1,648,606.00
06/11 06/11 Tarik ATM - S1AWKD0I /6848732994/ATM-POOLSUDIRMA 300,000.00 D 1,348,606.00
06/11 06/11 - UBP60148960801FFFFFF896081515613450 151,020.00 D 1,197,586.00
07/11 07/11 - UBP60148930801FFFFFF893081515613450 51,000.00 D 1,140,586.00
08/11 08/11 Tarik ATM - S1AW1NTO /7884489032/ATM-KPTDARMOSGN 300,000.00 D 846,586.00
08/11 08/11 - 20231108DANAIDJ101009978015549 100,000.00 946,586.00
08/11 08/11 - 20231108OENAIDJA01000259396605 12,000.00 958,586.00
08/11 08/11 - 150,000.00 1,108,586.00
09/11 09/11 - UBP60148930801FFFFFF893081515613450 101,000.00 D 1,007,586.00
09/11 09/11 - 20231108OENAIDJA0100262294658 100,000.00 1,107,586.00
09/11 09/11 MOM InhouseTrf - 150,000.00 1,257,586.00
10/11 10/11 - S1RHKNOC /7848671972/ATM-OB MMUPASAR 600,000.00 D 657,586.00
10/11 10/11 - UBP60148930801FFFFFF893081515613450 131,000.00 D 526,586.00
10/11 10/11 - 20231110BRINDJA01000281719191 150,000.00 676,586.00
11/11 11/11 - UBP60148960801FFFFFF896081515613450 124,000.00 D 552,586.00
11/11 11/11 Tarik ATM - S1AW1DTO /6884482407/ATM-KAPTENDULHA 300,000.00 D 252,586.00
12/11 12/11 - UBP60148890891FFFFFF8890831134098342 1 42,737.00 D 109,849.00
Kepada Yth / To No. Rekening/Account Number : 178-00-0342964-0
17800 Nama Produk/Product Nama : MANDIRI TAB PAYROLL
ARIEF BAKHTIAR LUTFI Valuta/Currency : Indonesia Rupiah
JL KH KHOLIL GG 17-A NO 4 Periode/Period : 01/07/23 s/d 27/12/23
RT 006 RW 001 Cabang/Branch : KC Gresik Kartini
Kebungson GRESIK 61115 No. Kartu/Card Number : 0032988662033393
No. NPWP/NPWP Number : -

8662033393

HALAMAN: 10

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

12/11 Saldo Pemindahan 259,849.00

14/11 14/11 - 20231114DANAIDJ101009937878892 150,000.00 259,849.00
15/11 15/11 MOM InhouseTrf - wifi bulan nopember 2023 150,000.00 409,849.00
15/11 15/11 - S1ITPKA012/6951 /LMP-99000000009/G1 350,000.00 D 59,849.00
15/11 15/11 - 20231115OENAIDJA01000286505868 150,000.00 209.849.00
16/11 16/11 Tarik ATM - S1AW1DTO /6884483300/ATM-KAPTENDULHA 150,000.00 D 59,849.00
19/11 19/11 - 20231119OENAIDJA01000297437053 150,000.00 209,849.00
19/11 19/11 - 20231119BMRIIDJA01000220642334 150,000.00 D 59,849.00
19/11 19/11 - 20231119BMRIIDJA01000220642334 2,500.00 D 57,349.00
19/11 19/11 - 20231119DANAIDJ101009984292741 150,000.00 207,349.00
20/11 20/11 MOM InhouseTrf - 150,000.00 357,349.00
20/11 20/11 - UBP60148930801FFFFFF893081515613450 51,000.00 D 306,349.00
20/11 20/11 MOM InhouseTrf - 150,000.00 456,349.00
21/11 21/11 MOM InhouseTrf - wifi november user 22 96 300,000.00 756,349.00
21/11 21/11 Tarif Link - 01005994 /0089994545/ATB-0000000000920 50,000.00 D 706,349.00
21/11 21/11 Tarif Link - 01005994 /0089994545/ATB-0000000000920 7,500.00 D 698,849.00
21/11 21/11 Tarif Link - 01005994 /0089994796/ATB-0000000000920 100,000.00 D 598,849.00
21/11 21/11 Tarif Link - 01005994 /0089994796/ATB-0000000000920 7,500.00 D 591,349.00
21/11 21/11 - 20231121BMRIIDJA01000221424292 300,000.00 D 291,349.00
21/11 21/11 - 20231121BMRIIDJA01000221424292 2,500.00 D 288,849.00
22/11 22/11 - 20231122BNINIDJA01000299770634 75,000.00 363,849.00
22/11 22/11 Tarik ATM - S1AW1NT0 /7884481923/ATM-KPTDARMOSGN 100,000.00 D 263,849.00
22/11 22/11 MOM InhouseTrf - DANA001015612212249 200,000.00 463,849.00
22/11 22/11 - MONTHLY CARD CHARGE 0006032988662033393 3,500.00 D 460,349.00
23/11 23/11 - 20231123BRINIDJA01000231716198 150,000.00 610,349.00
23/11 23/11 - 75851912 /0000528874/VAP- 329,494.00 D 280,855.00
24/11 24/11 - UBP60148930801FFFFFF893081515613450 53,000.00 D 227,855.00
24/11 24/11 - 20231124OENAIDJA01000208954468 150,000.00 377,855.00
24/11 24/11 - 20231124BMRIIDJA01000222684888 80,000.00 D 297,855.00
24/11 24/11 - 20231124BMRIIDJA01000222684888 2,500.00 D 295,355.00
25/11 25/11 Tarik ATM - S1AW1DTO /6884485385/ATM-KAPTENDULHA 250,000.00 D 45,355.00
Kepada Yth / To No. Rekening/Account Number : 178-00-0342964-0
17800 Nama Produk/Product Nama : MANDIRI TAB PAYROLL
ARIEF BAKHTIAR LUTFI Valuta/Currency : Indonesia Rupiah
JL KH KHOLIL GG 17-A NO 4 Periode/Period : 01/07/23 s/d 27/12/23
RT 006 RW 001 Cabang/Branch : KC Gresik Kartini
Kebungson GRESIK 61115 No. Kartu/Card Number : 0032988662033393
No. NPWP/NPWP Number : -

8662033393

HALAMAN: 11

Tgl. Tgl. Val Rincian Transaksi / No. Refrensi Debet / Kredit Saldo
Date Val.Date Description / Reference No. Debet / Credit Balance

25/11 Saldo Pemindahan 125,355.00

26/11 26/11 - 20231126BNINIDJA01000204134950 80,000.00 125,355.00
26/11 26/11 - 20231126BMRIIDJA01000227411980 55,000.00 D 70,355.00
26/11 26/11 - 20231126BMRIIDJA01000227411980 2,500.00 D 67,855.00
26/11 26/11 MOM InhouseTrf - bayar wifi awas atek lemot 150,000.00 217,855.00
26/11 26/11 Tarik ATM - S1W1DTO /6884485715/ATM-KAPTENDULHA 100,000.00 D 117,855.00
27/11 27/11 MOM InhouseTrf - 125,000.00 242,855.00
27/11 27/11 Tarik ATM - S1AW14TU /5284853782/ATM-SUNANGIRI 0 100,000.00 D 142,855.00
29/11 29/11 Tarik ATM - S1AW14TP /5284800061/ATM-POOLSUDIRMA 100,000.00 D 42,855.00
30/11 30/11 MOM InhouseTrf - SHOPEE_200001012 A170135026446077090 155,000.00 197,855.00
30/11 30/11 Biaya Adm - 6,000.00 D 191,855.00
01/12 01/12 - 20231201DANAIDJ101009904650649 200,000.00 391,855.00
01/12 01/12 Tarik ATM - S1AWK40A /5248658246/ATM-V-MART 02 200,000.00 D 191,855.00
02/12 02/12 - UBP60148930801FFFFFF893081515613450 51,000.00 D 140,855.00
02/12 02/12 MOM InhouseTrf - DANA001015713675149 100,000.00 240,855.00
02/12 02/12 - 20231202BMRIIDJA01000225489249 68,000.00 D 172,855.00
02/12 02/12 - 20231202BMRIIDJA01000225489249 2,500.00 D 170,355.00
03/12 03/12 Tarik ATM - S1AW1DTO /6884487440/ATM-KAPTENDULHA 100,000.00 D 70,355.00
07/12 07/12 - UBP60148930801FFFFFF893081515613450 31,000.00 D 39,355.00
07/12 07/12 MOM InhouseTrf - GAJI PT KSS 9,090,025.00 9,129,380.00
07/12 07/12 - 20231207BMRIIDJA01000226869417 225,000.00 D 9,904.380.00
07/12 07/12 - 20231207BMRIIDJA01000226869417 2,500.00 D 9,901,880.00
07/12 07/12 MOM InhouseTrf - talaman 800,000.00 D 9,101,880.00
07/12 07/12 - 20231207BMRIIDJA01000226910677 6,000,000.00 D 2,101,880.00
07/12 07/12 - 20231207BMRIIDJA01000226910677 2,500.00 D 2,099,380.00
09/12 09/12 - 20231207BMRIIDJA01000221948501 60,000.00 D 2,039,380.00
10/12 10/12 - 20231207BMRIIDJA01000221948501 2,500.00 D 2,036,880.00
17/12 17/12 - 20231207DANAIDJ101009963371349 200,000.00 2,236,880.00
20/12 20/12 - 20231207BMRIIDJA01000222304911 1,200,000.00 D 1,036,880.00
23/12 23/12 - 20231207BMRIIDJA01000222304911 2,500.00 D 1,034,380.00
27/12 27/12 - UBP60148961801FFFFFF8961806422605128 311,341.00 D 723,039.00