Name Department Position Vehicle No

Rifai Indraswari Sales Sales Engineer B 3367 UQP

Petrol/Milleage Claim Form

Content.Date Content.Customer Content.Division Content.Secured PO

12/20/2021 PT Mane Indonesia Industrial Yes
12/21/2021 PT Nichias Rookwol AutoJet Not Yet
1/4/2022 PT Karya Mandiri Industrial Not Yet
1/5/2022 PT Mayora Indah Industrial Not Yet
1/14/2022 PT Sekar Laut AutoJet Not Yet
1/20/2022 PT Egamekinka Industrial Not Yet
1/28/2022 PT Saritama Food Processing AutoJet Not Yet
3/8/2022 PT Sugizindo Industrial Not Yet
3/11/2022 PT Oneject Indonesia AutoJet Not Yet
3/16/2022 PT Unilever Indonesia Industrial Yes
3/23/2022 PT Aqua Golden Mississippi Industrial Not Yet
3/26/2022 PT Pratapa Nirmala AutoJet Not Yet
3/31/2022 PT Saritama Food Processing AutoJet Not Yet
4/6/2022 PT Sugizindo Industrial Yes
4/19/2022 PT Sugizindo Industrial Yes
4/20/2022 PT Trimita Adiperdana Industrial Not Yet
4/21/2022 PT Sugizindo Industrial Yes
4/22/2022 PT Lasallefood Indonesia AutoJet Yes
5/12/2022 PT Mayora Indah Industrial Not Yet
5/13/2022 PT Saritama Food Processing AutoJet Not Yet
5/19/2022 PT Lasallefood Indonesia AutoJet Yes
5/21/2022 PT Nutrifood Indonesia AutoJet Not Yet
5/27/2022 PT Torabika Eka Semesta Industrial Not Yet
6/3/2022 PT Lasallefood Indonesia AutoJet Not Yet
6/3/2022 PT Indra Jaya Teknik AutoJet Yes
6/8/2022 PT Tirta Investama Industrial Yes
6/9/2022 PT Mane Indonesia Industrial Yes
6/15/2022 PT Malindo Feedmill Indonesia PathoSans Not Yet
6/29/2022 PT HM Sampoerna Industrial Yes
7/6/2022 PT Saritama Food Processing AutoJet Yes
7/7/2022 Universitas Indonesia Industrial Yes
7/11/2022 PT Saritama Food Processing AutoJet Yes
7/13/2022 PT Monde Mahkota Biscuit Industrial Not Yet
7/20/2022 PT Altek Presisi Industrial Yes
7/22/2022 PT Anitox Indonesia International Industrial Yes
7/25/2022 PT Tirta Investama Industrial Yes
7/26/2022 PT Tirta Investama Industrial Yes
8/18/2022 PT Torabika Eka Semesta Industrial Yes
8/25/2022 PT Mane Indonesia Industrial Yes
8/29/2022 PT Aroma Kopikrim Indonesia AutoJet Yes
9/2/2022 PT Tirta Investama Industrial Yes
 9/9/2022 PT Lasallefood Indonesia AutoJet Yes
9/11/2022 PT Aroma Kopikrim Indonesia AutoJet Yes
9/14/2022 PT Indofood CBP Sukses Makmur Industrial Not Yet
9/18/2022 PT Aroma Kopikrim Indonesia AutoJet Yes
9/20/2022 PT Heinz ABC Industrial Yes
9/21/2022 PT Aroma Kopikrim Indonesia AutoJet Yes
9/25/2022 PT Aroma Kopikrim Indonesia AutoJet Yes
9/28/2022 PT Aroma Kopikrim Indonesia AutoJet Yes
10/5/2022 PT Mane Indonesia Industrial Yes
10/6/2022 Expo Clean PathoSans Not Yet
10/7/2022 Expo Clean PathoSans Not Yet
10/12/2022 PT DLBS Industrial Not Yet
10/14/2022 PT Sorini Agro Asia Industrial Not Yet
10/16/2022 Jakarta Marathon Industrial Not Yet
10/19/2022 PT Altek Presisi Industrial Yes
10/20/2022 PT Sasana Cipta Mandiri AutoJet Not Yet
10/21/2022 PT Tirta Investama AutoJet Yes
10/24/2022 PT Kertas Padalarang AutoJet Yes
10/25/2022 PT Altek Presisi Industrial Yes
11/11/2022 PT Saritama Food Processing AutoJet Yes
11/12/2022 PT Tirta Investama Industrial Yes
11/14/2022 PT Saritama Food Processing AutoJet Yes
11/15/2022 PT Tirta Investama Industrial Yes
11/16/2022 PT Saritama Food Processing AutoJet Yes
11/17/2022 PT Saritama Food Processing AutoJet Yes
11/25/2022 PT Saritama Food Processing AutoJet Yes
11/28/2022 PT Saritama Food Processing AutoJet Yes
11/29/2022 PT Saritama Food Processing AutoJet Yes
11/30/2022 PT Lasallefood Indonesia AutoJet Yes
12/12/2022 PT Sayap Mas Utama AutoJet Yes
12/13/2022 PT Stahlindo Engineering Industrial Yes
 Month From Month To AutoJet Industrial TeeJet
12 12 7,536,590 2,965,175 0

Content.# of KM's Content.Amount Content.Gas Content.Toll Content.Parking

88 78,000 78,000 0 0
71 160,000 160,000 0 0
45 50,000 50,000 0 0
49 68,000 68,000 0 0
49 72,000 72,000 0 0
38 78,175 78,175 0 0
74 450,000 370,000 71,000 9,000
120 86,000 86,000 0 0
98 92,000 92,000 0 0
93 84,000 84,000 0 0
84 50,000 50,000 0 0
58 69,000 69,000 0 0
54 72,000 72,000 0 0
76 71,000 71,000 0 0
76 76,000 76,000 0 0
60 53,000 53,000 0 0
76 62,000 62,000 0 0
68 73,000 73,000 0 0
64 68,000 68,000 0 0
54 58,000 58,000 0 0
68 63,000 63,000 0 0
127 102,000 0 97,000 5,000
119 94,000 94,000 0 0
34 114,000 114,000 0 0
34 129,500 129,500 0 0
86 75,000 75,000 0 0
96 78,000 78,000 0 0
164 624,580 536,580 88,000 0
150 127,000 127,000 0 0
54 78,000 78,000 0 0
76 88,000 88,000 0 0
54 70,000 70,000 0 0
60 78,000 78,000 0 0
52 66,000 66,000 0 0
30 50,000 50,000 0 0
32 52,000 52,000 0 0
84 85,000 85,000 0 0
93 94,000 94,000 0 0
58 75,000 75,000 0 0
471 497,000 497,000 0 0
84 98,000 98,000 0 0
 51 87,000 87,000 0 0
471 954,430 579,430 375,000 0
48 11,000 0 11,000 0
471 1,103,000 701,000 402,000 0
150 61,000 0 61,000 0
471 690,610 315,610 375,000 0
471 264,500 264,500 0 0
471 782,000 394,000 388,000 0
58 135,000 100,000 35,000 0
5 0 0 0 0
5 0 0 0 0
74 35,000 0 35,000 0
156 241,000 150,000 91,000 0
44 0 0 0 0
79 51,000 0 51,000 0
88 45,000 0 45,000 0
104 254,100 212,100 42,000 0
282 271,000 271,000 0 0
79 35,000 0 35,000 0
72 45,500 0 45,500 0
94 242,000 200,000 42,000 0
72 53,000 0 53,000 0
106 35,000 0 35,000 0
72 349,650 288,650 61,000 0
36 26,500 0 26,500 0
72 39,000 0 39,000 0
72 44,000 0 44,000 0
72 61,500 0 61,500 0
80 336,800 292,800 44,000 0
30 29,500 0 29,500 0
72 235,000 200,000 35,000 0
PathoSans Fluid Air Total Amount Total KM Personal Justification Usage Cust#
624,580 0 11,126,345 7,849 0% 72

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Name Rifai Indraswari Claim Date 21-Jan-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 20/Dec 2021- 25/Jan 2022 Special Note :

Month Jan
Year 2022

AutoJet 232,000
Industrial 274,175
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 506,175

TOTAL KM 340
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

12/20/2021 PT Mane Indonesia Industrial Yes 88 Err:507 78,000 0
12/21/2021 PT Nichias Rookwol AutoJet Not Yet 71 Err:507 160,000 0
1/4/2022 PT Karya Mandiri Industrial Not Yet 45 Err:507 50,000 0
1/5/2022 PT Mayora Indah Industrial Not Yet 49 Err:507 68,000 0
1/14/2022 PT Sekar Laut AutoJet Not Yet 49 Err:507 72,000 0
1/20/2022 PT Egamekinka Industrial Not Yet 38 Err:507 78,175 0
Parking
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 21-Feb-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 25/Jan 2021- 24/Feb 2022 Special Note :

Month Jan
Year 2022

AutoJet 450,000
Industrial 0
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 450,000

TOTAL KM 74
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas

1/28/2022 PT Saritama Food Processing AutoJet Not Yet 74 Err:507 370,000
 Toll Parking
71,000 9,000
Name Rifai Indraswari Claim Date 21-Mar-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 26/Feb 2022- 25/Mar 2022 Special Note :

Month Mar
Year 2022

AutoJet 92,000
Industrial 220,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 312,000

TOTAL KM 395
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

3/8/2022 PT Sugizindo Industrial Not Yet 120 Err:507 86,000 0
3/11/2022 PT Oneject Indonesia AutoJet Not Yet 98 Err:507 92,000 0
3/16/2022 PT Unilever Indonesia Industrial Yes 93 Err:507 84,000 0
3/23/2022 PT Aqua Golden Mississippi Industrial Not Yet 84 Err:507 50,000 0
Parking
0
0
0
0
Name Rifai Indraswari Claim Date 20-Apr-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode DD/Mmm - DD/Mmm YYYY Special Note :

Month Mmm
Year YYYY

AutoJet 141,000
Industrial 147,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 288,000

TOTAL KM 264
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

3/26/2022 PT Pratapa Nirmala AutoJet Not Yet 58 Err:507 69,000 0
3/31/2022 PT Saritama Food Processing AutoJet Not Yet 54 Err:507 72,000 0
4/6/2022 PT Sugizindo Industrial Yes 76 Err:507 71,000 0
4/19/2022 PT Sugizindo Industrial Yes 76 Err:507 76,000 0
Parking
0
0
0
0
Name Rifai Indraswari Claim Date 20-May-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 20/Apr 2022- 20/May 2022 Special Note :

Month May
Year 2022

AutoJet 194,000
Industrial 183,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 377,000

TOTAL KM 390
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

4/20/2022 PT Trimita Adiperdana Industrial Not Yet 60 Err:507 53,000 0
4/21/2022 PT Sugizindo Industrial Yes 76 Err:507 62,000 0
4/22/2022 PT Lasallefood Indonesia AutoJet Yes 68 Err:507 73,000 0
5/12/2022 PT Mayora Indah Industrial Not Yet 64 Err:507 68,000 0
5/13/2022 PT Saritama Food Processing AutoJet Not Yet 54 Err:507 58,000 0
5/19/2022 PT Lasallefood Indonesia AutoJet Yes 68 Err:507 63,000 0
Parking
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 21-Jun-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 20/May 2022- 21/June 2022 Special Note :

Month June
Year 2022

AutoJet 345,500
Industrial 247,000
TeeJet 0
PathoSans 624,580
Fluid Air 0
GRAND TOTAL 1,217,080

TOTAL KM 660
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

5/21/2022 PT Nutrifood Indonesia AutoJet Not Yet 127 Err:507 0 97,000
5/27/2022 PT Torabika Eka Semesta Industrial Not Yet 119 Err:507 94,000 0
6/3/2022 PT Lasallefood Indonesia AutoJet Not Yet 34 Err:507 114,000 0
6/3/2022 PT Indra Jaya Teknik AutoJet Yes 34 Err:507 129,500 0
6/8/2022 PT Tirta Investama Industrial Yes 86 Err:507 75,000 0
6/9/2022 PT Mane Indonesia Industrial Yes 96 Err:507 78,000 0
6/15/2022 PT Malindo Feedmill Indonesia PathoSans Not Yet 164 Err:507 536,580 88,000
Parking
5,000
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 21-Jul-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 21/June 2022- 21/July 2022 Special Note :

Month July
Year 2022

AutoJet 148,000
Industrial 359,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 507,000

TOTAL KM 446
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

6/29/2022 PT HM Sampoerna Industrial Yes 150 Err:507 127,000 0
7/6/2022 PT Saritama Food Processing AutoJet Yes 54 Err:507 78,000 0
7/7/2022 Universitas Indonesia Industrial Yes 76 Err:507 88,000 0
7/11/2022 PT Saritama Food Processing AutoJet Yes 54 Err:507 70,000 0
7/13/2022 PT Monde Mahkota Biscuit Industrial Not Yet 60 Err:507 78,000 0
7/20/2022 PT Altek Presisi Industrial Yes 52 Err:507 66,000 0
Parking
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 21-Aug-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 22/July 2022- 23/Agt 2022 Special Note :

Month Agt
Year 2022

AutoJet 0
Industrial 281,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 281,000

TOTAL KM 239
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

7/22/2022 PT Anitox Indonesia International Industrial Yes 30 Err:507 50,000 0
7/25/2022 PT Tirta Investama Industrial Yes 32 Err:507 52,000 0
7/26/2022 PT Tirta Investama Industrial Yes 84 Err:507 85,000 0
8/18/2022 PT Torabika Eka Semesta Industrial Yes 93 Err:507 94,000 0
Parking
0
0
0
0
Name Rifai Indraswari Claim Date 20-Sep-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 2817 UIA Approved By

Periode 22/ Agt 2022- 20/Sep 2022 Special Note :

Month Sep
Year 2022

AutoJet 2,641,430
Industrial 184,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 2,825,430

TOTAL KM 1654
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

8/25/2022 PT Mane Indonesia Industrial Yes 58 Err:507 75,000 0
8/29/2022 PT Aroma Kopikrim Indonesia AutoJet Yes 471 Err:507 497,000 0
9/2/2022 PT Tirta Investama Industrial Yes 84 Err:507 98,000 0
9/9/2022 PT Lasallefood Indonesia AutoJet Yes 51 Err:507 87,000 0
9/11/2022 PT Aroma Kopikrim Indonesia AutoJet Yes 471 Err:507 579,430 375,000
9/14/2022 PT Indofood CBP Sukses Makmur Industrial Not Yet 48 Err:507 0 11,000
9/18/2022 PT Aroma Kopikrim Indonesia AutoJet Yes 471 Err:507 701,000 402,000
Parking
0
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 20-Oct-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 2817 UIA Approved By

Periode 20/ Sep 2022- 21/Okt 2022 Special Note :

Month Okt
Year 2022

AutoJet 2,036,210
Industrial 523,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 2,559,210

TOTAL KM 2176
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

9/20/2022 PT Heinz ABC Industrial Yes 150 Err:507 0 61,000
9/21/2022 PT Aroma Kopikrim Indonesia AutoJet Yes 471 Err:507 315,610 375,000
9/25/2022 PT Aroma Kopikrim Indonesia AutoJet Yes 471 Err:507 264,500 0
9/28/2022 PT Aroma Kopikrim Indonesia AutoJet Yes 471 Err:507 394,000 388,000
10/5/2022 PT Mane Indonesia Industrial Yes 58 Err:507 100,000 35,000
10/6/2022 Expo Clean PathoSans Not Yet 5 Err:507 0 0
10/7/2022 Expo Clean PathoSans Not Yet 5 Err:507 0 0
10/12/2022 PT DLBS Industrial Not Yet 74 Err:507 0 35,000
10/14/2022 PT Sorini Agro Asia Industrial Not Yet 156 Err:507 150,000 91,000
10/16/2022 Jakarta Marathon Industrial Not Yet 44 Err:507 0 0
10/19/2022 PT Altek Presisi Industrial Yes 79 Err:507 0 51,000
10/20/2022 PT Sasana Cipta Mandiri AutoJet Not Yet 88 Err:507 0 45,000
10/21/2022 PT Tirta Investama AutoJet Yes 104 Err:507 212,100 42,000
Parking
0
0
0
0
0
0
0
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 20-Nov-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 2817 UIA Approved By

Periode 20/ Sep 2022- 21/Okt 2022 Special Note :

Month Okt
Year 2022

AutoJet 745,650
Industrial 312,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 1,057,650

TOTAL KM 813
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

10/24/2022 PT Kertas Padalarang AutoJet Yes 282 Err:507 271,000 0
10/25/2022 PT Altek Presisi Industrial Yes 79 Err:507 0 35,000
11/11/2022 PT Saritama Food Processing AutoJet Yes 72 Err:507 0 45,500
11/12/2022 PT Tirta Investama Industrial Yes 94 Err:507 200,000 42,000
11/14/2022 PT Saritama Food Processing AutoJet Yes 72 Err:507 0 53,000
11/15/2022 PT Tirta Investama Industrial Yes 106 Err:507 0 35,000
11/16/2022 PT Saritama Food Processing AutoJet Yes 72 Err:507 288,650 61,000
11/17/2022 PT Saritama Food Processing AutoJet Yes 36 Err:507 0 26,500
Parking
0
0
0
0
0
0
0
0
Name Rifai Indraswari Claim Date 22-Dec-22
Department Sales Prepared By Rifai Indraswari
Position Sales Engineer Checked By
Vehicle No B 2817 UIA Approved By

Periode 24/Nov - 20/Dec 2022 Special Note :

Month Dec
Year 2022

AutoJet 510,800
Industrial 235,000
TeeJet 0
PathoSans 0
Fluid Air 0
GRAND TOTAL 745,800

TOTAL KM 398
Personal Justification Usage 0%

Petrol/Milleage Claim Form

Date Customer Division Secured PO # of KM's Amount Gas Toll

25-Nov-22 PT Saritama Food Processing AutoJet Yes 72 39,000 0 39,000
28-Nov-22 PT Saritama Food Processing AutoJet Yes 72 44,000 0 44,000
29-Nov-22 PT Saritama Food Processing AutoJet Yes 72 61,500 0 61,500
30-Nov-22 PT Lasallefood Indonesia AutoJet Yes 80 336,800 292,800 44,000
12-Dec-22 PT Sayap Mas Utama AutoJet Yes 30 29,500 0 29,500
13-Dec-22 PT Stahlindo Engineering Industrial Yes 72 235,000 200,000 35,000

28-Nov Office - PT Saritama Food

Processing

29-Nov Office - PT Saritama Food

Processing

30-Nov Office - PT Lasallefood

Indonesia

12-Dec Office - PT Sayap Mas

Utama

13-Dec Office - PT Stahlindo

15-Dec Office - PT Aroma Kopikrim

Indonesia
Parking
0
0
0
0
0
0
Office Use Only Sales Engineer Sales Christianus Mulia Wijaya
AutoJet Frans Budi Setiawan
Industrial Malianti
TeeJet Ridho Ilahi
PathoSans Mutriadi
Fluid Air Fransisca Sinaga
Pahala Darisman
Rifai Indraswari
Not Yet
Yes