Month/Year Claim No. Batch No.

EC Number Claim Status Brand

08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
08/2023 MEICS2023080043 Open TOSHIBA
 WO No. Service Vendor Code
MEIWO23070M89048480001
MEIWO23070M89048480001
MEIWO23070M89048480001
MEIWO23070M89048480001
MEIWO23080M89048480001
MEIWO23080M89048480001
MEIWO23080M89048480001
MEIWO23080M89048480001
MEIWO23080M89048480001
Service Partner Name Service Vendor Number
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
KHOLIS HAMDI LUBIS M89048480001
 Service Vendor Name Product Line Part Code Qty Fee Local Name
KHOLIS HAMDI LUBIS LAD 11002012030746 1 Single phase asynchronous motor YXBT-
KHOLIS HAMDI LUBIS LAD Transportation 1 Transportation Fee
KHOLIS HAMDI LUBIS LAD 11002012030748 1 Single phase asynchronous motor YXB-1
KHOLIS HAMDI LUBIS LAD Labour 1 Labour Fee
KHOLIS HAMDI LUBIS LAD Transportation 1 Transportation Fee
KHOLIS HAMDI LUBIS LAD Labour 1 Labour Fee
KHOLIS HAMDI LUBIS REF Labour 1 Labour Fee
KHOLIS HAMDI LUBIS REF Other 1 Other Cost
KHOLIS HAMDI LUBIS REF Transportation 1 Transportation Fee
 Audit Time Amount (Before Tax) WHT VAT Total Fee Type Remarks
e asynchronous motor YXBT- 221000 0 221000 Spare part
40000 0 0 40000 Transport
e asynchronous motor YXB-1 282000 0 282000 Spare part
130000 0 0 130000 Labour
40000 0 0 40000 Transport
100000 0 0 100000 Labour
170000 0 0 170000 Labour
110000 0 0 110000 Freon
40000 0 0 40000 Transport
 ASP Name Source Number Service Partner Local Service Vendor Name
KHOLIS HAMDI MEIWO230702308 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
KHOLIS HAMDI MEIWO230800551 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
KHOLIS HAMDI MEIWO230800072 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
 Product Line Fee Status Source Type Warranty Type Amount Tax Amount
VH-H75MN(WB)@920Submitted WO In Warranty 673000 0
AW-M901BN(WW)@9 Submitted WO In Warranty 140000 0
GR-RD196CC-DMF[3Submitted WO In Warranty 320000 0
Total Amount Claim Number Branch Name Branch Code Wht Tax Amount
673000 MEICS2023080043 CSD JAKARTA O00001530 0
140000 MEICS2023080043 CSD JAKARTA O00001530 0
320000 MEICS2023080043 CSD JAKARTA O00001530 0
Wht Tax Rate is Package Created by Creation Date Labour
0 ex_cca.agent 2023-08-28 11:52:00 130,000
0 ex_cca.agent 2023-08-18 17:22:01 100,000
0 ex_cca.agent 2023-08-16 15:52:01 170,000
400,000
Transport Freon Spare part Amount Tax Amount
40,000 - 503,000 673,000 -
40,000 - - 140,000 -
40,000 110,000 - 320,000 -
120,000 110,000 503,000 1,133,000 -
Total Amount Amount WO SP Labour Transport Freon Spare part
673,000.00 1 1 1 1 - 2
140,000.00 1 - 1 1 - -
320,000.00 1 - 1 1 1 -
1,133,000
WARRANTY CLAIM ACCOUNT PAYABLE
Period : August-23
MEICS2023080043

SERVICE
NO AUTHORIZE NAME AREA pph 23 LABOR
CALL
1 KHOLIS HAMDI LUBIS Err:504 3 Rp 400,000.00

GRAND TOTAL 3 Rp 400,000

PAYMENT TO : MASS ACCOUNT NUMBER

MASS PAYMENT
August
Previous
Service Ending Balance
No MASS Name City Balance
Call A/R
AR
1 KHOLIS HAMDI LUBIS Err:504 3 0 0

TOTAL 3 0 0

Date : 08 Aug 2023

Prepared By

Erina pratiwi
 EVIDENCE REPORT
August-23

LABOR A/P BALANCE

TRANSPORT FREON SPAREPART (MINUS (IDR Include
PPH 23) Tax)
Rp 120,000.00 Rp 110,000.00 Rp 503,000.00 Rp 1,133,000.00

Rp 120,000 Rp 110,000 Rp 503,000 Rp 1,133,000

MASS PAYMENT SUMMARY

August-23

Ending Balance Different MASS Payment MIDEA Payment

A/P Payable Amount Date Amount Date
1,133,000

1,133,000 0 0 0 0

Checked By Approved By

Khalis Kurniadi Leo Ariefyanto

=

Parts Ex Balance Payment

Used & AP Proposal
1,133,000

0 0 1,133,000
 INVOICE
Bill To: Ship To:

PT.Midea Planet Indonesia PT.Midea Planet Indonesia

Perwata Tower Lt.3 Perwata Tower Lt.3
Jl. Pluit Selatan Raya Kav.1 Jl. Pluit Selatan Raya Kav.1
Jakarta Utara 14440 Jakarta Utara 14440
Phone: (021) 29072647 Phone: (021) 29072647

Date/Month Invoice Number Settlment Partner Period

01 September 2023 002/INV/KHL/IX/2023 KHOLIS HAMDI LUBIS August-23

No Service Partner QTY Amount

PKG/MGT Fee 0 Rp -
Non Package WO 3 Rp 630,000
KPI Bonus 0 Rp -
1 KHOLIS HAMDI LUBIS
Sparepart 1 Rp 503,000
Adjustment 0 Rp -
Sub Total Rp 1,133,000
Vat 11% Rp -
AR
Total Rp 1,133,000
WHT 2%
Balance Due Rp 1,133,000

Amount Rp 1,133,000
Amount Said one million one hundred thirty three thousand Rupiah

Payment Able to

Payee : KHOLIS HAMDI LUBIS

Bank Name : BANK RAKYAT INDONESIA
Account No. : 704001011122533
NPWP : KHOLIS HAMDI LUBIS
Account No. : 75.333.417.6-115.000
KHOLIS HAMDI LUBIS

Note :
NO
 Note :
(Nominal <5juta TTD, STEMPEL) (Nominal
>5juta TTD,STEMPEL,MATERAI)Di print
dikirim bersamaan dengan dokumen
Attachment (maksimal 3 hari setelah Admin
Midea Email)

Yang dikirim :
1. INVOICE
2.FAKTUR PAJAK (jika ada ppn)
3. BP/MISA/SR , ATTACHMENT
SESUAI SISTEM

Up : ERINA/DIANA - ADMIN WCB CSD

081293290146 DIKIRIM KE ALAMAT YANG BARU
MIDEA (RUKO KETAPANG
BUSINESS CENTER) BLOK A NO.8 Jl. Kyai
Haji Zainul Arifin No.8 RW.7 Krukut ,
Kec.Taman sari, Kota Jakarta Barat, Daerah
Khusus Ibukota Jakarta 11140
 PAYMENT REQUEST FORM
Standard/Settlement/Advance
✘

PRF No. : R01 Month : AUG PRF No. : R01/AUG/HO-CSD/2023

Branch : HO Dept： CSD Budget Source : Non-Sales Policy

CURRENCY : RP AMOUNT : 1,133,000

SAY : one million one hundred thirty three thousand Rupiah

DESCRIPTION :
Description : Claim warranty service
Beneficiary KHOLIS HAMDI LUBIS
Period Aug-23

Supporting Docs Summary Claims

Attachment AR & AP
Invoice

DUE DATE :

Payment Method : Transfer ✘

Cash

Payee : KHOLIS HAMDI LUBIS Bank Name : BANK RAKYAT INDONESIA

APPLICANT SERVICE OPERATION HEAD OF DEPT FINANCE & ACCOUNTING

Sign : Sign : Sign : Sign :

Name : Erina Pratiwi Name : Khalis Kurniadi Name : Leo Ariefyanto Name :
Date : 08 Aug 2023 Date : Date : Date :

Notes:
REQUEST FORM
tlement/Advance
R01/AUG/HO-CSD/2023 BA No. :

Non-Sales Policy Activity : Category : All Prod

1,133,000

hree thousand Rupiah ✘

MEICS2023080043

Giro

Account Number : 704001011122533

ACCOUNTING SENIOR MANAGER PRESIDENT DIRECTOR

Sign : Sign :

Name : Name :
Date : Date :