BUKTI TRANSAKSI NG BN I Jumlah Dibayar Ke Bank Status Pembayaran Nomor Transaksi ID Transaksi ‘Amount Biaya Admin Total Amount Tanggal Transaksi BPJS KESEHATAN Detail Transaksi Status Transaksi Sukses Transaction Retference 202207088907430540 From Account 3000666659 Nomor Billing 8888890002800862 Nama PT PAGUNTAKA CAHAYA NUSANTARA (ULD KAPUAS) Cabang 1401 - PALANGKARAYA Total luran IDR 16.926.592,00 luran Dibayar IDR 16.326.592,00 ‘Admin Bank 0 IDR 16.326.592,00 BERHASIL, LUNAS 791638 6E8C9534E5651102 FP 16.926.592 FPO AP 16.326.592 ‘78122 4:57 PM Harap simpan resi ini sebagai bukti transaksi yang sah Terima kasih telah bertransaksi menggunakan BNIDirect Please keep this receipts as a proof of legitimate transaction ‘Thank you for doing transaction using BNIDirectBPJS Kesehatan Pelaporan Penagihan mre rian Sot Billing Statement Yth. PT PAGUNTAKA CAHAYA NUSANTARA (ULD KAPUAS) JLBARITO NO. 29 KOTA PALANGKARAYA 73112 ‘Jumiah yang Harus | Jumlah Pegawat Tanggat Jatu Nomor Virtual Account Tanggungan | Tanggat Cotak ‘Dibayarkan "Number of| Tempo Virtual Account Number paente tebe badd” | eee Siaterment Date | pag ktt™®, Dae | BNI -8888890002800862 BRI :8888890002800862 yo7/202 MOR spesseuvnsepoee2 «(AP 16.926.592 102 2aros/2022 so/o7/2022 BTN :8888890002800862 ‘Tanggal Transeks! Keterangan Transaks! Jumian, Transaction date Transaction Descrtion ‘Amount 1 ie ‘Saldo Awal Tagihan Previous Balance Rp. 16.26.5902 16/06/2022 Pembayaran Previous Payment Rp. 16.826.592 CR Jul 2022 _Premi/luran Contribution Rp. 16.326,592 Total Tagihan Total Balance Rp. 16.326.592 Kolektibilitas. Lancar Collectibilty Current ‘Syorat dan Ketentua aa. ikl nama Badan Usaha (besarbiaya dilelapkan olgh masing-masing Bank) Pembayaran pang lamba cterma cleh BPJS Kesehatan pada tanggal aluh tempo yaitu tanggal 10 setiap bulannya Pembayaran melas bank lan akan efetf terima BPJS Kesohatan 2© 4. hal kerja setelan pembayaran dakukan, Untuk menghindariKeteramibatan, silahkan lakukan pembayaran 2 6.4.3 hari kerja sebelum tanggaljluh tempo. Apabia tera perbedaan otal taghan, mohon menghuburgi Kantor Cabang BPS Kesehatan untuk melakukan rekonsiias! sebelum tanggal 20 bulan berjalan. Keleiharvcokurangan dari hasi rekonsikasi akan cipertungkan pada taginan bulan berkutrya, Dalam hat ferdapat keterlambatan pembayaran iran loth dar (stu) bulan, penjaminan peserta cberhentkan sementara ‘Apabia dalam waktu 4S (empatpuluh lima) har sejak status kepesertaan ait Kembali, Badan Usaha wb membayar denda kepada BPJS. Pembayaran dapat dlahukan melalui Bank BNI, BF, Mandi, atau BTN dengan mencantumkan Nomor Vital Account sebagaimana tertera Pembayaran dapat diakukan melli Bank iain (King ATG) dengan mencantumkan Nomor Vital Account sebagaimana tetera di stas Kesehatan untuk seap pelayanan kesehalan awa inap yang diperolehnya sebesar 5% dar biaya pelayanan kesehalan uniukselan bulan lertunguak, Terima kasih ata parisipasi Anda dalam program Jaminan Kesehalan Nasional - Kart indonesia Sehat "Dengan gotong-royang semua tertolong”TURAN PESERTA BADAN USAHA a no neat o2zo7o2t00800000001 oor 8u ‘nscosen i Sen namasu PT PAGUNTAKA CANAYA NUSANTARA ULDKAPUAS) caro ome TA Toe aaa [Re Psa oa > —[ nga Kaa | — Pre Toor 37 [oo1621 8 |BTUAAT aaa Peseta 1a 2 enoo1974338 0000119578338 [NENANOR E stra e500 57 osontisnnser fonoosi6nns615 [cuNAWat is peseeta ress 4 owoo 3825 |oo001 71713825 [NENG a serra 763403 5 Tewoocos2aons [one0c037a083 [aN BARGE a pesenra e632 ¢-emoos759751 noo 759751 [Mz AGUNG KAROMIAWARN a serra rr] 3 enobes 773425 ono0e 773025 [NORMAN SSSTnTeoOT Peseta E5383 enone onone06a47s [ro ans o pesenta Tei 3 foresees [oices585445 [RELA io reser real oni be1565445 oon os4585456 | Mn ARTHAS ist 3 i Joooioeses44s ooosssesen85 | REY OTAVO aa 3 12 [ooo osaessis oootoases esta AUASTASTA aac a 73 Jooo0s796585 000105785835 AnMAD Za 5 ese Ta it Joons134 70908 [00034370998 [WANDA a besa sa8e27 15 Joooi1s7095 oooiies93e45 [vanrina io ism 3 6 oots4170958[onns1e7051165[ MUTARATATEAT ana a 277 ]oo0 11370958 00011713195 [ MUAMMIAD ZA AGAR Dak 9 48 oni iser709n8|oo0s2e0852495 | MUVAnMvAD NAUEAL ROADS ana 3 13 [ooos9a6475[oooises647s7 Arana Ic PeSenTA a3 30 [ooot139368757 [oot seaeoiss [Tian WATTELER is 7 31 _oo11sea657[ooii7essae [asa PUSPA ANGGTA Tawar a 29 oot iessexsi nossa [wnwanan is sera Ta oot assess ooms30528004[ANORAWAT? 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