Month/Year Batch No. EC Number Claim Status Brand Claim No.

2/29/2024 Open TOSHIBA MEICS20240201

2/29/2024 Open TOSHIBA MEICS20240201
2/29/2024 Open TOSHIBA MEICS20240201
2/29/2024 Open TOSHIBA MEICS20240201
2/29/2024 Open TOSHIBA MEICS20240201
2/29/2024 Open TOSHIBA MEICS20240201
 WO No. Service Partner Code Service Partner Name Category
MEIWO240100429 S4000699 KHOLIS HAMDI LUBIS LAD
MEIWO240100429 S4000699 KHOLIS HAMDI LUBIS LAD
MEIWO240100429 S4000699 KHOLIS HAMDI LUBIS LAD
MEIWO240100080 S4000699 KHOLIS HAMDI LUBIS REF
MEIWO240100080 S4000699 KHOLIS HAMDI LUBIS REF
MEIWO240100080 S4000699 KHOLIS HAMDI LUBIS REF
 Part Code Qty Fee Local Name Audit Time Amount (Before Tax) WHT
17438000016226 1 Washing Timer XPB65-801-DQ25A RoHS 84000
Transportation 1 Transportation Fee 40000 1000
Labour 1 Labour Fee 130000 3250
Labour 1 Labour Fee 170000 4250
12131000074938 1 Decoration component A0101-101 RoHS 188000
Transportation 1 Transportation Fee 40000 1000
VAT Total Fee Type Remarks Remarks
0 84000 Spare part Other Cost
0 39000 Transport Transportation Fee
0 126750 Labour Labour Fee
0 165750 Labour
0 188000 Spare part
0 39000 Transport
 ASP Name Source Number Service Partner Local Service Vendor Name
KHOLIS HAMDI MEIWO240100429 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
KHOLIS HAMDI MEIWO240100080 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
 Product Line Fee Status Source Type Warranty Type Amount Tax Amount
VH-H75MN(WR)@920Submitted WO In Warranty 254000 0
GR-RD196CC-DMF[3Submitted WO In Warranty 398000 0
Total Amount Claim Number Branch Name Branch Code Wht Tax Amount
249750 MEICS2024020130 CSD JAKARTA O00001530 4250
392750 MEICS2024020130 CSD JAKARTA O00001530 5250
Wht Tax Rate is Package Created by Creation Date Labour Transport
0 ascbk012 2024-02-29 16:52:01 130,000 40,000
0 ascbk012 2024-02-29 12:04:01 170,000 40,000
300,000 80,000
Freon Spare part Amount Tax Amount WHT Total Amount
- 84,000 254,000 - 4,250 249,750
- 188,000 398,000 - 5,250 392,750
- 272,000 652,000 - 9,500 642,500
WHT rate WHT Total Amount Amount WO SP Labour Transport Freon
2.50% 4,250 249,750.00 1 1 1 1 -
2.50% 5,250 392,750.00 1 1 1 1 -
Spare part
1 TRUE
1 TRUE
WARRANTY CLAIM ACCOUNT PAYABLE
Period : February-24
MEICS2024020130

SERVICE
NO AUTHORIZE NAME AREA pph 23 LABOR
CALL
1 KHOLIS HAMDI LUBIS Medan 2 Rp 300,000.00

GRAND TOTAL 2 Rp 300,000

PAYMENT TO : MASS ACCOUNT NUMBER

MASS PAYMEN
Februa
Previous
Service Ending Balance
No MASS Name City Balance
Call A/R
AR
1 KHOLIS HAMDI LUBIS Medan 2 0 0

TOTAL 2 0 0

Date :15 March 2024

Prepared By

Erina pratiwi
 EVIDENCE REPORT
February-24

LABOR A/P BALANCE

TRANSPORT FREON SPAREPART (MINUS (IDR Include
PPH 23) Tax)
Rp 80,000.00 Rp - Rp 272,000.00 Rp 652,000.00

Rp 80,000 Rp - Rp 272,000 Rp 652,000

MASS PAYMENT SUMMARY

February-24

Ending Balance MASS Payment MIDEA Payment

Different Payable
A/P Amount Date Amount Date
652,000

652,000 0 0 0 0

Checked By Approved By

Khalis Kurniadi Leo Ariefyanto

=

Parts Ex Balance Payment

Used & AP Proposal
652,000

0 0 652,000
 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

05 Maret 2024 006/INV/KHL/III/2024 KHOLIS HAMDI LUBIS February-24

No Service Partner QTY Amount

PKG/MGT Fee 0 Rp -
Labour 2 Rp 300,000
Transport 2 Rp 80,000
1 KHOLIS HAMDI LUBIS
Freon 0 Rp -
Sparepart 2 Rp 272,000
Sub Total Rp 652,000
Vat 11% Rp -
AR
Total Rp 652,000
WHT 2.5% Rp 9,500
Balance Due Rp 642,500

Amount Rp 642,500
Amount Said six hundred forty-two thousand five hundred 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. : R- Month : MAR PRF No. : R-/MAR/HO-CSD/2024

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

CURRENCY : RP AMOUNT : 642,500

SAY : six hundred forty-two thousand five hundred rupiah

DESCRIPTION :
Description : Claim warranty service
Beneficiary KHOLIS HAMDI LUBIS
Period Feb-24

Supporting Docs Summary Claims

Attachment AR & AP
Invoice

DUE DATE : 27 Maret 2024

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 :15 March 2024 Date : Date : Date :

Notes:
REQUEST FORM
tlement/Advance
R-/MAR/HO-CSD/2024 BA No. :

Non-Sales Policy Activity : Category : All Prod

642,500

five hundred rupiah ✘

MEICS2024020130

Giro

Account Number : 704001011122533

ACCOUNTING SENIOR MANAGER PRESIDENT DIRECTOR

Sign : Sign :

Name : Name :
Date : Date :