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 Not Yet
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 Industrial 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
 Month From Month To AutoJet Industrial
12 10 6,026,040 2,701,275

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

88 78,000 78,000 0
71 160,000 160,000 0
45 50,000 50,000 0
49 68,000 68,000 0
49 72,000 72,000 0
38 78,175 78,175 0
74 450,000 370,000 71,000
120 86,000 86,000 0
98 92,000 92,000 0
93 84,000 84,000 0
84 50,000 50,000 0
58 69,000 69,000 0
54 72,000 72,000 0
76 71,000 71,000 0
76 76,000 76,000 0
60 53,000 53,000 0
76 62,000 62,000 0
68 73,000 73,000 0
64 68,000 68,000 0
54 58,000 58,000 0
68 63,000 63,000 0
127 102,000 0 97,000
119 94,000 94,000 0
34 114,000 114,000 0
34 129,500 129,500 0
86 75,000 75,000 0
96 78,000 78,000 0
164 624,580 536,580 88,000
150 127,000 127,000 0
54 78,000 78,000 0
76 88,000 88,000 0
54 70,000 70,000 0
60 78,000 78,000 0
52 66,000 66,000 0
30 50,000 50,000 0
32 52,000 52,000 0
84 85,000 85,000 0
93 94,000 94,000 0
58 75,000 75,000 0
471 497,000 497,000 0
84 98,000 98,000 0
 51 87,000 87,000 0
471 954,430 579,430 375,000
48 11,000 0 11,000
471 1,103,000 701,000 402,000
150 61,000 0 61,000
471 690,610 315,610 375,000
471 264,500 264,500 0
471 782,000 394,000 388,000
58 135,000 100,000 35,000
5 40,000 0 0
5 45,000 0 0
74 35,000 0 35,000
156 241,000 150,000 91,000
44 29,000 0 0
79 51,000 0 51,000
88 45,000 0 45,000
104 254,100 212,100 42,000
282 271,000 271,000 0
79 35,000 0 35,000
72 45,500 0 45,500
94 242,000 200,000 42,000
72 53,000 0 53,000
106 35,000 0 35,000
72 349,650 288,650 61,000
36 26,500 0 26,500
 TeeJet PathoSans Fluid Air Total Amount Total KM
0 709,580 0 9,436,895 6,638

Content.Parking Name
0 ClaimForm01
0 ClaimForm01
0 ClaimForm01
0 ClaimForm01
0 ClaimForm01
0 ClaimForm01
9,000 ClaimForm02
0 ClaimForm03
0 ClaimForm03
0 ClaimForm03
0 ClaimForm03
0 ClaimForm04
0 ClaimForm04
0 ClaimForm04
0 ClaimForm04
0 ClaimForm05
0 ClaimForm05
0 ClaimForm05
0 ClaimForm05
0 ClaimForm05
0 ClaimForm05
5,000 ClaimForm06
0 ClaimForm06
0 ClaimForm06
0 ClaimForm06
0 ClaimForm06
0 ClaimForm06
0 ClaimForm06
0 ClaimForm07
0 ClaimForm07
0 ClaimForm07
0 ClaimForm07
0 ClaimForm07
0 ClaimForm07
0 ClaimForm08
0 ClaimForm08
0 ClaimForm08
0 ClaimForm08
0 ClaimForm09
0 ClaimForm09
0 ClaimForm09
 0 ClaimForm09
0 ClaimForm09
0 ClaimForm09
0 ClaimForm09
0 ClaimForm10
0 ClaimForm10
0 ClaimForm10
0 ClaimForm10
0 ClaimForm10
40,000 ClaimForm10
45,000 ClaimForm10
0 ClaimForm10
0 ClaimForm10
29,000 ClaimForm10
0 ClaimForm10
0 ClaimForm10
0 ClaimForm10
0 ClaimForm11
0 ClaimForm11
0 ClaimForm11
0 ClaimForm11
0 ClaimForm11
0 ClaimForm11
0 ClaimForm11
0 ClaimForm11
Personal Justification Usage Cust#
#REF! 58
Name Rifai Indraswari Claim Date
Department Sales Prepared By
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

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
 25-Jan-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll 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
Name Rifai Indraswari Claim Date
Department Sales Prepared By
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

1/28/2022 PT Saritama Food Processing AutoJet Not Yet
 24-Feb-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

74 450,000 370,000 71,000 9,000
Name Rifai Indraswari Claim Date
Department Sales Prepared By
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%

22

Date Customer Division Secured PO

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
 25-Mar-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
Position Sales Engineer Checked By
Vehicle No B 3367 UQP Approved By

Periode 26/Mar 2022- 20/Apr 2022 Special Note :

Month Apr
Year 2022

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

TOTAL KM 264
Personal Justification Usage 0%

Date Customer Division Secured PO

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
 20-Apr-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
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%

Date Customer Division Secured PO

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
 20-May-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
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%

Date Customer Division Secured PO

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
 21-Jun-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
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%

Date Customer Division Secured PO

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
 21-Jul-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
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%

Date Customer Division Secured PO

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
 23-Aug-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
Position Sales Engineer Checked By
Vehicle No B 3367 UQP 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%

Date Customer Division Secured PO

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
 20-Sep-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
Position Sales Engineer Checked By
Vehicle No B 3367 UQP 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%

Date Customer Division Secured PO

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
 24-Oct-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
 Rifai Indraswari Claim Date
Department Sales Prepared By
Position Sales Engineer Checked By
Vehicle No B 3367 UQP 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%

Date Customer Division Secured PO

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
 24-Oct-22
Rifai Indraswari

Note :

# of KM's Amount Gas Toll Parking

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
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
Anom Wijaya Daru
Not Yet
Yes