005INVKHLI2024

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

12/2023 MEICS2023120074 Open MIDEA
12/2023 MEICS2023120074 Open TOSHIBA
WO No. Service Vendor Code Service Partner Name
MEIWO231200224 S4000699 KHOLIS HAMDI LUBIS
Service Vendor Number Service Vendor Name Product Line Part Code Qty
S4000699 KHOLIS HAMDI LUBIS REF 17431000001031 1
S4000699 KHOLIS HAMDI LUBIS REF Transportation 1
S4000699 KHOLIS HAMDI LUBIS LAD Labour 1
S4000699 KHOLIS HAMDI LUBIS REF Labour 1
S4000699 KHOLIS HAMDI LUBIS LAD 11002012030748 1
S4000699 KHOLIS HAMDI LUBIS LAD Transportation 1
S4000699 KHOLIS HAMDI LUBIS LAD 12638000002241 1
S4000699 KHOLIS HAMDI LUBIS LAD 110020120307461
S4000699 KHOLIS HAMDI LUBIS REF Labour 1
S4000699 KHOLIS HAMDI LUBIS REF Other 1
S4000699 KHOLIS HAMDI LUBIS REF Transportation 1
Fee Local Name Audit Time Amount (Before Tax) WHT VAT Total
Signal compound thermostat 5024070500 75000 0 75000
Transportation Fee 40000 0 0 40000
Labour Fee 130000 0 0 130000
Labour Fee 180000 0 0 180000
Single phase asynchronous motor YXB-1 282000 0 282000
Water Sealer Assembly MTG80-P501Q-3 47000 0 47000
Labour Fee 130000 0 0 130000
Labour Fee 130000 0 0 130000
Single phase asynchronous motor YXBT-45 221000 0 221000
Labour Fee 130000 0 0 130000
PCB MAT70-1106_01FM-DK01 RoHS 6136 285000 0 285000
Washing Timer MTE65-P706S_91-ID-DQ25 112000 0 112000
Labour Fee 180000 4500 0 175500
Other Cost 110000 2750 0 107250
Fee Type Remarks Remarks
Spare part Other Cost
Transport Transportation Fee
Labour Labour Fee
Labour
Spare part
Transport
Transport
Spare part
Transport
Labour
Labour
Spare part
Labour
Spare part
Transport
Spare part
Labour
Freon
Transport
ASP Name Source Number Service Partner Local Service Vendor Name
KHOLIS HAMDI MEIWO231200224 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
KHOLIS HAMDI LMEIWO231200221 KHOLIS HAMDI LUBIS KHOLIS HAMDI LUBIS
Product Line Fee Status Source Type Warranty Type Amount Tax Amount
HS-258CK@9203201Submitted WO In Warranty 295000 0
VH-H75MN(WR)@920Submitted WO In Warranty 452000 0
VH-H75MN(WW)@920Submitted WO In Warranty 282000 0
AW-K801AN@920380Submitted WO In Warranty 455000 0
VH-H75MN(WR)@920Submitted WO In Warranty 438000 0
HS-259CNK@920320Submitted WO In Warranty 330000 0
Total Amount Claim Number Branch Name Branch Code Wht Tax Amount
295000 MEICS2023120074 CSD JAKARTA O00001530 0
Wht Tax Rate is Package Created by Creation Date Labour Transport
0 ascbk013 2023-12-28 13:20:03 180,000 40,000
0 ascbk013 2023-12-28 13:20:03 130,000 40,000
0 ascbk014 2023-12-28 13:20:02 130,000 40,000
0 ascbk013 2023-12-28 13:20:02 130,000 40,000
0 ascbk011 2023-12-28 13:20:02 130,000 40,000
2.5 ex_cca.agent 2023-12-22 12:22:01 180,000 40,000
Freon Spare part Amount Tax Amount WHT Total Amount
- 75,000 295,000 - 5,500 289,500
- 282,000 452,000 - 4,250 447,750
- 112,000 282,000 - 4,250 277,750
- 285,000 455,000 - 4,250 450,750
- 268,000 438,000 - 4,250 433,750
110,000 - 330,000 - 8,250 321,750
WHT rate WHT Total Amount Amount WO SP Labour Transport Freon
2.50% - 295,000.00 1 1 1 1 -
2.50% - 452,000.00 1 1 1 1 -
2.50% - 282,000.00 1 1 1 1 -
2.50% - 455,000.00 1 1 1 1 -
2.50% - 438,000.00 1 1 1 1 -
2.50% 8,250 321,750.00 1 - 1 1 1
Spare part
1 FALSE
1 FALSE
1 FALSE
1 FALSE
2 FALSE
- TRUE
WARRANTY CLAIM ACCOUNT PAYABLE
Period : December-23
MEICS2023120074
SERVICE
NO AUTHORIZE NAME AREA pph 23 LABOR
CALL
1 KHOLIS HAMDI LUBIS Medan 6 Rp 880,000.00
GRAND TOTAL 6 Rp 880,000
PAYMENT TO : MASS ACCOUNT NUMBER

MASS PAYMEN
Decemb
Previous
Service Ending Balance
No MASS Name City Balance
Call A/R
AR
1 KHOLIS HAMDI LUBIS Medan 6 0 0
TOTAL 6 0 0
Date : 15 Jan 2023

Prepared By
Erina pratiwi
EVIDENCE REPORT
December-23
LABOR A/P BALANCE

TRANSPORT FREON SPAREPART (MINUS (IDR Include
PPH 23) Tax)
Rp 240,000.00 Rp 110,000.00 Rp 1,022,000.00 Rp 2,252,000.00
Rp 240,000 Rp 110,000 Rp 1,022,000 Rp 2,252,000
MASS PAYMENT SUMMARY

December-23
Ending Balance MASS Payment MIDEA Payment

Different Payable
A/P Amount Date Amount Date
2,252,000
2,252,000 0 0 0 0
Checked By Approved By
Khalis Kurniadi Leo Ariefyanto

=
Parts Ex Balance Payment

Used & AP Proposal
2,252,000
0 0 2,252,000
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 Januari 2023 005/INV/KHL/I/2024 KHOLIS HAMDI LUBIS December-23
No Service Partner QTY Amount

PKG/MGT Fee 0 Rp -
Non Package WO 6 Rp 1,230,000
KPI Bonus 0 Rp -
1 KHOLIS HAMDI LUBIS
Sparepart 5 Rp 1,022,000
Adjustment 0 Rp -
Sub Total Rp 2,252,000
Vat 11% Rp -
AR
Total Rp 2,252,000
WHT 2.5% Rp 30,750
Balance Due Rp 2,221,250
Amount Rp 2,221,250
Amount Said two million two hundred twenty-one thousand two hundred fifty 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 : JAN PRF No. : R-/JAN/HO-CSD/2024
Branch : HO Dept： CSD Budget Source : Non-Sales Policy
CURRENCY : RP AMOUNT : 2,221,250
SAY : two million two hundred twenty-one thousand two hundred fifty rupi
DESCRIPTION :
Description : Claim warranty service
Beneficiary KHOLIS HAMDI LUBIS
Period Dec-23
Supporting Docs Summary Claims

Attachment AR & AP
Invoice
DUE DATE : 24 Januari 2023
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 Jan 2023 Date : Date : Date :
Notes:
REQUEST FORM
tlement/Advance
R-/JAN/HO-CSD/2024 BA No. :
Non-Sales Policy Activity : Category : All Prod
2,221,250
-one thousand two hundred fifty rupiah

✘
MEICS2023120074
Giro
Account Number : 704001011122533
ACCOUNTING SENIOR MANAGER PRESIDENT DIRECTOR

Sign : Sign :
Name : Name :
Date : Date :

005INVKHLI2024

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Month/Year Claim No. Batch No.

EC Number Claim Status Brand

GRAND TOTAL 6 Rp 880,000

PAYMENT TO : MASS ACCOUNT NUMBER

Date : 15 Jan 2023

LABOR A/P BALANCE

Rp 240,000 Rp 110,000 Rp 1,022,000 Rp 2,252,000

MASS PAYMENT SUMMARY

Ending Balance MASS Payment MIDEA Payment

Khalis Kurniadi Leo Ariefyanto

Parts Ex Balance Payment

PT.Midea Planet Indonesia PT.Midea Planet Indonesia

Date/Month Invoice Number Settlment Partner Period

No Service Partner QTY Amount

Payee : KHOLIS HAMDI LUBIS

Up : ERINA/DIANA - ADMIN WCB CSD

PRF No. : R- Month : JAN PRF No. : R-/JAN/HO-CSD/2024

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

CURRENCY : RP AMOUNT : 2,221,250

Supporting Docs Summary Claims

DUE DATE : 24 Januari 2023

Payment Method : Transfer ✘

Payee : KHOLIS HAMDI LUBIS Bank Name : BANK RAKYAT INDONESIA

APPLICANT SERVICE OPERATION HEAD OF DEPT FINANCE & ACCOUNTING

Non-Sales Policy Activity : Category : All Prod

-one thousand two hundred fifty rupiah

Account Number : 704001011122533

ACCOUNTING SENIOR MANAGER PRESIDENT DIRECTOR

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