PT.

BANK KALIMANTAN TENGAH

CABANG SAMPIT
JL. A. YANI NO.7
Kepada Yth:
NO. REKENING PUSKESMAS KETAPANG UNITI
:3000102001855 NAMA
MATA UANG :IDR - INDONESIAN RUPIAH NOCIF 0000234322
NPWP 082188975780 HP: 082188975780
:703797878712000 NO TELP
PERIODE 01/12/2022 s.d 31/12/2022 ALAMAT

REKENING KORAN GIRO

Hal 1 dari 2
Saldo D/K Userld Cab Lok
No. Tgl. No. Arsip Kode Mutasi Debet Mutasi Kredit
Keterangan
SALDO AWAL 144,823,100.00 K
149,345,200.00 K skngw 100
1 01/12/2022 SKNOO0O12
5
299 SKN DARI BNINIDJA(BPJS
KESEHATAN - ASET DJS)-
4,522,100.00

Non Kapitasi 01/12/22

-T98928D4F5B000F9 149,583,200.00 K n0018 300
2 02/12/2022 no01800059 201 02122022 238,000.00

3 02/12/2022 no01800060 201 02122022 128,500.00 149,711,7o0.00 K n0018 300

4 02/12/2022 n001800061 201 02122022 420,000.00 150,131,700.00 K n0018 300

5 05/12/2022 nO01800117 201 SETORAN TUNAI 200,000.00 150,331,70o.00 K n0018 300

6 05/12/2022 n001800118 201 SETORAN TUNAI 236,500.00 150,568,200.00 K nO018 300

150,752,200.00 K do026 300
7 07/12/2022 do02800058 201 retribuai
07122022 184,000.00

8 07/12/2022 do02600059 201 SETORAN TUNAI 239,000.00 150,991,200.00 K d0026 300

9 09/12/2022 n001800065 201 RET PEL KES 09 DES 2022 55,000.00 151,046,200.00 K no018 300

10 09/12/2022 n001800066 201 RET PUSK KETAPANG 08 238,500.00 151,284,700.00 K n0018 300
DES 2022
11 09/12/2022 SI00039034 297 0011/sp2d- 24,954,916.00 176,239,616.00 K extgw 300
tu/PUSK.KETAPANG/2022
12 13/12/2022 n001800044 102 PENARIKAN TUNAI 137,800,000.00 38,439,616.00 K n0018 300
(CHEQUE) AN. RAHMI NO

13 13/12/2022
CEK CKB244929
no01800045 102 PENARIKAN TUNAl 24,954,916.00 13,484,700.00 K n0018 300
(CHEQUE) AN. RAHMI NO
CEK CKB244930
14 13/12/2022 n001800152 201 SETORAN TUNAI 580,000.00 14,064,700.00 K n0018 300

15 13/12/2022 n001800153 201 SETORAN TUNAI 160,500.00 14,225,200.00 K n0018 300

16 13/12/2022 n001800154 201 SETORAN TUNAI 185,500.00 14,410,700.00 K no018 300

17 15/12/2022 SKNO00014 299 SKN DARI BNINIDJA(BPJS 100,512,700.00 114,923,400.00 K skngw 100
2 KESEHATAN ASET DJS)-
KAPITASI DESEMBER 2022
T98928D83736A15E
18 15/12/2022 n001800054 201 SETORAN TUNAI 160,5 0.0 115,083,900.00 K n0018 300
19 15/12/2022 n001800055 201 SETORAN TUNA 236,000.00 115,319,900.00 K n0018 300
20 16/12/2022 do02800090 201 SETORAN TUNAI 254,500.00 115,574,400.00 K d0026 300
RETRIBUSI 181222
21 19/12/2022 doo2600283 201 SETORAN TUNAI 378,500.00 115,952,900.00 K d0026 300
22 19/12/2022 doo2800284 201 SETORAN TUNAI 186,000.00 116,138,900.00 K do026 300
23 22/12/2022 n001800092 201 SETORAN TUNAI 349,000.00 116,487,900.00 K n0018 300
24 22/12/2022 n001800093 201 SETORAN TUNAI 467,500.00 116,955,400.00 K no018 300
25 22/12/2022 no01800094 201 SETORAN TUNAI 413,500.00 117,368,900.00 K n0018 300
28 23/12/2022 n001800067 201 SETORAN TUNAI 293,000.00 117,661,900.00 K n0018
27 26/12/2022 001800018 102 PENARIKAN TUNA 30,000,000.00
(CHEQUE) AN. RAHMI NO 87,661,900.00 K no018 300
CEK CKB244931
28 26/12/2022 do02600116 201 retribusi 26122022
308,500.00 87,970,400.00 K d0026 300
29 26/12/2022 do02600117 201 retribusi 24122022
466,000.00 88,436,400.00 K do026 300
30 26/12/2022 SKNOO001 299 SKN DARI BNINIDJA(BPJS
5,962,100.00 94,398,500.00 K skngw 100
 Kepada Yth:
NO. REKENING 3000102001855
MATA UANG
NAMA :PUSKESMAS KETAPANG UNITI
IDR INDONESIAN RUPIAH NO CIF : 0000234322
NPWP 703797878712000 NO TELP 082188975780 HP: 082188975780
PERIODE 01/12/2022 s.d 31/12/2022 ALAMAT

REKENING KORAN GIRO

Hal 2 dari 2

No. Tgl. No. Arsip Kode Keterangan Mutasi Debet Mutasi Kredit Saldo D/K Userld Cab Lok
SALDO AWAL 144,823,100.00 K
13 KESEHATAN- ASET DJS)-
Non Kapitasi 26/22

31 26/12/2022 SKNO00015 299 T98928DAC7672D81

SKN DARI BNINIDJA(BPJS 2,857,100.00 97,255,600.00 K skngw 100
2 KESEHATAN ASET DJS)
Promprev 26/22
T98928DAC7672EAC
32 28/12/2022 d002600087 201 RETRIBUSI 28122022 97,603,100.00 K do0026 300
347,500.00
33 29/12/2022 dO02600152 201 RETRIBUSI 29122022 97,941,600.00 K d0026 300
338,500.00
34 30/12/2022 n001800113 201 SETORAN TUNAI 162,500.00 98,104,100.00 K n0018 300

35 31/12/2022 9930648134 201 TRF_INT_MB_627405300068 97,500.00 98,201,600.00 K 99300 994

8726
36 31/12/2022 JASGOOOO0 299 JSA GIRO 12 2022 NO CEK 0 6,119.00 98,207,719.00 K s9999 300
06
37 31/12/2022 JASAO0O00 199 JSA GIRO KE 6,119.00 98,201,600.00 K s9999 300
05 3000101001549 NO CEKO
SALDO AWAL 144,823,100.00 K
MUTASI DB 192,761,035.00
MUTASI KR 146,139,535.00
SALDO AKHIR 98,201,600.00 K

Bilamana selama 14 hari setelah menerima Rekening Koran inl, kami tldak menerima tanggapan apapun,
maka kami menganggap bahwa rekening koran ini telah disetujui,
SAMPIT
ANK3 Januari 2023 11:54:34

CABANG
Printed By: INDAH GANTINI AMP