Alfa Mart

FORM TANDA PENYERAHAN TTF
CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
: BALI
:
17-Jun-13
: PT. PARAGON DISTRIBUSINDO
: QZ01.P.0677.1.E
:
PENYERAHAN FAKTUR (PF)

No Telp
No. Fax.
Contact Person
Faktur
No.LPB
No
E13-027724
E13-027721
E13-022812
E13-018593
E13-020379
10030732-E-0637
10030732-E-0650
10030732-E-0559
10030732-E-0427
10030732-E-0472
:
:
:
Faktur Pajak
Rp
497,436
431,076
4,729,081
353,699
2,697,256
No
010.000.13.00007752
010.000.13.00007753
010.000.13.00007712
010.000.13.00007579
010.000.13.00007631
Rp
497,437
431,077
4,729,092
353,700
2,697,413
Kami setuju dengan ketentuan penyerahan faktur yang berlaku di PT. Sumber Alfaria Trijaya
Tanda Tangan & Nama Kolektor

NB: Semua kolom yang terdapat di Form Tanda Penyerahan TTF ini harus diisi dengan lengkap & benar
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
: BALI
:
17-Jun-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No.LPB
No
E13-032426
E13-027721
E13-022812
E13-018593
E13-020379
Faktur Pajak
Rp
10030732-E-0874
10030732-E-0650
10030732-E-0559
10030732-E-0427
10030732-E-0472
:
:
:
9,075,904
431,076
4,729,081
353,699
2,697,256
Rp
No
010.000.13.00007752
010.000.13.00007753
010.000.13.00007712
010.000.13.00007579
010.000.13.00007631
497,437
431,077
4,729,092
353,700
2,697,413

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
B13-014428
B13-014252
:
:
:
:
:
BALI
20-Feb
PT TAMARIN JAYA
QZ01.
tamarinjaya_ds@yahoo.com
No Telp
No. Fax.
Contact Person
Faktur
No
10030732-B-0322
10030732-B-0261
:
:
:
Faktur Pajak
Rp
No
1651308 010.000.13.00008264
2380979 010.000.13.00008024
Rp
1651308
2380941
Kami setuju dengan ketentuan penyerahan faktur yang berlaku di PT Sumber Alfari Trijaya

Total
Alfaria Trijaya
(0370)648555
(0370)624823
Ayu Hartini
Total
Alfari Trijaya

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
: BALI
:
10-Jul-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
:
:
:
Faktur Pajak
Rp
No
Rp
F13-015163
10030732-F-0383
810,945 010.901-13.25956541
811,039
F13-016015
10030732-F-0288
5,735,037 010.901-13.25956540
5,735,325
F13-018839
10030732-F-0506
2,476,184 010.901-13.25956598
2,476,627
F13-018835
10030732-F-0475
3,671,608 010.901-13.25956597
3,671,595
F13-018842
10030732-F-0452
4,339,244 010.901-13.25956596
4,339,233
F13-023589
10030732-F-0557
3,994,239 010.901-13.25956706
3,994,615
G13-001508
10030732-F-0767
2,602,227 010.901-13.25956851
2,603,080
F13-028318
10030732-F-0635
2,996,893 010.901-13.25956765
2,997,808
G13-006824
10030732-G-0043
4,952,764 010.901-13.25956885
4,954,184
G13-006604
100307302-G-0146
1,888,876 010.901-13.25956884
1,889,553

Total
rijaya
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
: BALI
:
23-Jul-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
:
:
:
Faktur Pajak
Rp
No
Rp
G13-017946
10030732-G-0432
958,251 010.901-13.25957189
958,326
G13-018483
10030732-G-0423
251,213 010.901-13.25957188
251,365
G13-018395
10030732-G-0435
573,929 010.901-13.25957142
574,057
G13-016710
10030732-G-0350
853,202 010.901-13.25957144
853,277
G13-016714
10030732-G-0291
245,969 010.901-13.25957143
246,024
G13-022043
10030732-G-0495
327,959 010.901-13.25957204
328,032
G13-022045
10030732-G-0474
327,959 010.901-13.25957203
328,032
G13-009461
10030732-G-0188
5,059,251 010.901-13.25956939
5,060,762
G13-009174
10030732-G-0114
327,959 010.901-13.25956954
328,032
G13-013901
10030732-G-0271
456,067 010.901-13.25957077
456,122
G13-023462
10030732-G-0603
2,649,082 010.901-13.25957245
2,649,934

Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
: BALI
:
29-Jul-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No.LPB
No
G13-031249
G13-024345
G13-024369
10030732-G-0708
10030732-G-0615
10030732-G-0632
:
:
:
Faktur Pajak
Rp
No
2,016,615 010.901-13.25957336
485,414 010.901-13.25957282
1,513,043 010.901-13.25957264
Rp
2,017,212
485,542
1,513,323

Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
H13-006124
H13-002527
H13-002619
H13-013807
H13-012439
G13-035155
: BALI
:
22-Aug-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
:
:
:
Faktur Pajak
Rp
No
Rp
10030732-H-0044
2,379,607 010.901-13.25957550 9350
2,380,162
10030732-G-0862
2,246,889 010.901-13.25957534 9334
2,246,879
10030732-G-0854
4,731,734 010.901-13.25957535 9335
4,732,185
10030732-H-0230
6,586,413 010.901-13.25957686 9486
6,588,473
10030732-H-0183
1,147,857 010.901-13.25957629 9429
1,148,114
10030732-G-0780
2,722,661 010.901-13.25957423 9223
2,723,639

Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
H13-026117
H13-022534
H13-020114
H13-021945
: BALI
:
4-Sep-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
:
:
:
Faktur Pajak
Rp
No
Rp
10030732-H-0670
676,251 010.901-13.25957960 9760
676,350
10030732-G-0419
1,004,084 010.901-13.25957874 9674
1,004,384
10030732-G-0300
4,234,335 010.901-13.25957767 9567
4,236,139
10030732-H-0342
3,163,899 010.901-13.25957823 9623
3,164,883

Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
I13-005040
I13-002621
I13-000933
I13-000983
I13-000973
I13-000985
I13-000960
: BALI
:
11-Sep-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
Faktur Pajak
Rp
No
Rp
10030732-H-0865
6,368,210 010.901-13.25958158 9958
6,369,563
10030732-H-0838
9,802,044 010.901-13.25958134 9934
9,804,885
10030732-I-0032
3,234,944 010.901-13.25958100 9900
3,235,646
10030732-H-0629
5,825,451 010.901-13.25958096 9896
5,827,049
10030732-H-0688
5,813,743 010.901-13.25958097 9897
5,814,470
10030732-I-0033
2,218,005 010.901-13.25958099 9899
2,218,698
10030732-I-0034
2,969,399 010.901-13.25958098 9898
2,970,315

:
:
:
Rp
6,369,563
9,804,885
3,235,646
5,827,049
5,814,470
2,218,698
2,970,315
aria Trijaya
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
I13-019301
I13-019298
I13-019300
I13-019299
I13-011228
I13-014361
I13-014355
: BALI
:
2-Oct-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
:
:
:
Faktur Pajak
Rp
No
Rp
10030732-I-0492
4,786,832 010.901-13.25958207 10262
9,576,328
10030732-I-0474
2,349,020 010.901-13.25958205 10264
2,349,009
10030732-I-0498
951,125 010.901-13.25958204 10263
951,341
10030732-I-0414
1,129,233 010.901-13.25958203 10207
1,129,275
10030732-I-0176
425,862 010.901-13.25958200 10071
426,096
10030732-I-0332
1,404,496 010.901-13.25958202 10155
1,404,597
10030732-I-0213
5,923,616 010.901-13.25958201 10027
5,923,590

Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
J13-001928
J13-001927
J13-001929
J13-009690
J13-011486
J13-009774
J13-031218
J13-034399
I13-031204
I13-034394
J13-013191
: BALI
:
23-Oct-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
10030732-J-0037
10030732-J-0069
10030732-J-0027
10030732-J-0131
10030732-J-0207
10030732-J-0293
10030732-I-0910
10030732-I-1010
10030732-I-0821
10030732-I-0945
10030732-J-0277
:
:
:
Faktur Pajak
Rp
1,490,586
1,021,313
1,866,205
540,799
853,609
1,866,205
2,139,549
2,845,695
1,441,508
1,064,704
1,587,992
Rp
No
010.902-13.47658019
010.902-13.47658020
010.902-13.47658021
010.902-13.47658119
010.902-13.47658142
010.902-13.47658120
010.902-13.47657866
010.902-13.47657973
010.902-13.47657838
010.902-13.47657951
010.902-13.47658195
10726
10727
10728
10810
10822
10811
10568
10670
10505
10646
10883

1,491,336
1,021,308
1,866,316
541,065
853,642
1,866,316
2,139,500
2,846,606
1,441,504
1,065,240
1,588,522
Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
J13-029040
J13-032356
J13-033621
J13-017004
K13-003174
K13-003173
K13-002078
J13-025298
J13-025297
K13-013072
K13-013087
K13-010961
K13-013018
: BALI
:
19-Oct-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
10030732-J-0715
10030732-J-0816
10030732-J-0862
10030732-J-0377
10030732-J-1039
10030732-K-0011
10030732-J-0938
10030732-J-0577
10030732-J-0553
10030732-K-0320
10030732-K-0249
10030732-K-0190
10030732-K-0174
:
:
:
Faktur Pajak
Rp
8,465,755
1,611,440
210,097
1,300,052
1,215,052
4,358,895
1,296,073
2,714,928
1,970,955
340,199
6,561,579
933,767
2,657,703
Rp
No
010.902-13.47658398
010.902-13.47658508
010.902-13.47658540
010.902-13.47658230
010.902-13.47658711
010.902-13.47658712
010.902-13.47658693
010.902-13.47658328
010.902-13.47658326
010.902-13.47658901
010.902-13.47658900
010.902-13.47658810
010.902-13.47658811
11136
11244
11276
10937
11445
11446
11427
11070
11068
11633
11632
11543
11544

8,467,179
1,611,622
210,098
1,300,267
1,215,238
4,359,577
1,296,416
2,715,185
1,971,362
340,263
6,562,493
933,768
2,658,236
Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
K13-024401
K13-024402
K13-016895
K13-017096
K13-003174
: BALI
:
27-Nov-13
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
10030732-K-0598
10030732-K-0528
10030732-K-0439
10030732-K-0409
10030732-J-1039
Faktur Pajak
Rp
1,257,421
797,191
210,051
8,719,055
1,215,052
No
010.902-13.47658708
010.902-13.47659142
010.902-13.47659003
010.902-13.47659004
010.902-13.47658711
11442
11874
11735
11736
11445

:
:
:
aktur Pajak
Rp
1,257,596
797,359
210,098
8,720,547
1,215,238
lengkap & benar
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
L13-001106
L13-006026
L13-008324
L13-011377
L13-016722
L13-018453
L13-018460
L13-021114
L13-024514
L13-025341
L13-030257
: BALI
:
7-Jan-14
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
10030732-K-0993
10030732-L-0116
10030732-L-0081
10030732-L-0172
10030732-L-0223
10030732-L-0346
10030732-L-0290
10030732-L-0362
10030732-L-0391
10030732-L-0439
10030732-L-0507
:
:
:
Faktur Pajak
Rp
11,440,210
6,449,001
3,777,787
2,707,197
4,133,892
622,957
283,036
339,643
473,390
599,119
666,480
Rp
No
010.902-13.96000420
010.902-13.96000487
010.902-13.96000518
010.902-13.96000582
010.902-13.96000628
010.902-13.96000725
010.902-13.96000724
010.902-13.96000724
010.902-13.96000793
010.902-13.96000827
010.902-13.96000896
12158
12211
12242
12307
12353
12464
12463
12482
12532
12566
12635

11,442,122
6,450,367
3,778,066
2,707,741
4,134,183
623,050
283,074
339,689
473,476
599,216
666,618
Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
L13-034176
A14-005599
A14-024719
A14-016767
A14-018194
A14-024613
A14-028834
: BALI
:
30-Jan-14
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
10030732-L-0555
10030732-A-0194
10030732-A-0760
10030732-A-0499
10030732-A-0401
10030732-A-0553
10030732-A-0739
:
:
:
Faktur Pajak
Rp
113,214
532,865
3,948,669
7,749,621
9,847,116
452,857
3,203,875
Rp
No
010.902-13.96000962
010.902-13.96001081
010.000-14.99453625
010.902-13.96001192
010.902-13.96001321
010.000-14.99453816
010.000-14.99453883
12701
12822
12997
12934
13064
13164
13249

113,230
532,984
3,949,308
7,750,868
9,848,660
452,918
3,204,354
Total
Total

CABANG
Tanggal
Nama Supplier
Kode Supplier
Alamat Email
No.LPB
A14-016767
A14-018194
A14-032025
A14-032030
A14-034242
A14-040465
A14-040462
B14-006282
: BALI
:
19-Feb-14
: QZ01.P.0677.1.E
:

No Telp
No. Fax.
Contact Person
Faktur
No
10030732-A-0499
10030732-A-0401
10030732-A-0825
10030732-A-0898
10030732-A-0949
10030732-A-1420
10030732-A-1216
10030732-A-1391
:
:
:
Faktur Pajak
Rp
7,749,621
9,847,116
1,143,366
13,770,277
438,493
891,628
2,018,259
2,469,439
Rp
No
010.000-14.99453573
010.000-14.99453727
010.000-14.99453925
010.000-14.99453930
010.000-14.99454008
010.000-14.99454037
010.000-14.99454081
010.000-14.99454174
12934
13064
13295
13300
13339
13348
13462
13556

7,750,868
9,848,660
1,143,524
13,773,078
438,549
891,755
2,018,591
2,469,786
Total
Total

Alfa Mart

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FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

lengkap & benar

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

FORM TANDA PENYERAHAN TTF

PENYERAHAN FAKTUR (PF)

Tanda Tangan & Nama Kolektor

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