DAFTAR TENAGA KERJA KELUAR

Nama Perusahaan :
PT. RIAU AGUNG KARYA ABADI

NPP

DD003500
No.
1
2
3
4
5
6
7
8
9

Nomor Induk Karyawan

(NIK)

Unit Kerja :
KANTOR DIREKSI & KEBUN LIBO

Nomor KPJ
11006532094
11012980097
11002897459

Nama Tenaga Kerja

ANTO ARITONANG
SUDIARTO PANDIANGAN
WAHYUDI

Jumlah seluruhnya

Upah bulan lalu

(Rp)
1,150,000
1,150,000
1,150,000

3,450,000

\\vboxsrv\conversion_tmp\scratch21244\[97810551.xls.ms_office.xls]Daftar
Pekan Baru, 07 Desember 2011

Leli Hasda Julita

Ka. Personalia

Formulir
Jamsostek

1b

Periode laporan :
Nov-11
Halaman :
dari :
Keterangan

1.1007E+10
1.1003E+10
1.1003E+10
1.1003E+10
1.1E+10
1.1007E+10
1.1013E+10
1.1013E+10
1.1007E+10

Pekan Baru, 07 Desember 2011

Leli Hasda Julita

Ka. Personalia

Formulir

2
REKAPITULASI RINCIAN PEMBAYARAN IURAN
BAGIAN I - Perusahaan
1. Perusahaan : PT. RIAU AGUNG KARYA ABADI

No. Pendaftaran (NPP)

DD003500

2. Iuran untuk bulan/tahun : Nop 2011

3. Iuran disetor melalui:
Bank

BANK MANDIRI

Kantor Pos
Kantor Jamsostek
BAGIAN II - Rekapitulasi tenaga kerja dan upah (JKK, JHT, JK)
Jumlah

Uraian
Tenaga Kerja
A

Bulan lalu

Upah (Rp.)

228

268,050,000

Penambahan Tenaga Kerja ( Form Jamsostek No.F1a)

8,700,000

Pengurangan Tenaga Kerja ( Form Jamsostek No.F1b)

3,450,000

Kenaikan Upah

Jumlah ( A + B - C + D )

231

273,300,000

BAGIAN III - Rekapitulasi tenaga kerja dan Upah (JPK)*)

Peserta

Uraian
TK
A

Bulan lalu

Penambahan Tenaga Kerja (Form Jamsostek No. F1a)

Pengurangan Tenaga Kerja (Form Jamsostek No. F1b)

Kenaikan Upah

Jumlah ( A + B - C + D)

TKKel

Upah (Rp)*)

Kel TTG

TKL

TKKel

BAGIAN IV - Rincian iuran bulan ini

Program

Tarif Jumlah Upah (Rp.)

(1)
A

Jaminan Kecelakaan Kerja (JKK)

(2)

(3)

Jumlah Iuran (Rp.)

(4) = (2) x (3)

0.54 %

273,300,000

1,475,820

Jaminan Hari Tua (JHT)

5.7 %

273,300,000

15,578,100

Jaminan Kematian (JKM)

0.3 %

273,300,000

819,900

Jaminan Pemeliharaan Kesehatan ( JPK )

3.0 %

62,000,000

1,860,000

6.0 %

169,000,000

10,140,000

Jumlah ( A + B + C + D )

29,873,820

BAGIAN V - Kekurangan/kelebihan**)) iuran untuk bulan: tahun..

Uraian
A

Jaminan Kecelakaan Kerja (JKK)

Jaminan Hari Tua (JHT)

Jaminan Kematian (JK)

Jaminan Pemeliharaan Kesehatan ( JPK )

Jumlah ( A + B + C + D)

Jumlah Iuran (Rp.)

BAGIAN VI - Denda iuran

Jumlah Denda Iuran

BAGIAN VII - Jumlah Seluruhnya

29,873,820

Jumlah Seluruhnya ( IV + V + VI)

Nama dan tandatangan pimpinan perusahaan

Jabatan

Keterangan :
1. TKL = Lajang TK Kel = berkeluarga
2. *) Upah diatas 1 juta dihitung Rp. 1 Juta
**) Coret yang tidak perlu
3. Bagian III di isi jika mengikuti Program JPK
4. Formulir Jamsostek 2 wajib di isi setiap bulan dan diserahkan kepada PT. Jamsostek (Persero) bersamaan
dengan pembayaran iuran serta dilampirkan dengan :
a. Formulir Jamsostek 1a bila ada penambahan tenaga kerja
b. Formulir Jamsostek 1b bila ada pengurangan tenaga kerja

07 Des 2011

c. Formulir Jamsostek 2a bila terjadi perubahan upah dan jumlah tenaga kerja

2300000
6400000

268050000
5,250,000

12,000,000

30,255,830

62
169

RINCIAN IURAN TENAGA KERJA

NPP

Nama Perusahaan

Nama Unit Kerja

DD 003500

RIAU AGUNG KARYA ABADI

KEBUN LIBO & KANTOR DIREKSI

Periode Laporan

11
Bulan

No.

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31

Nomor KPJ

11002897103
11006532136
11012979966
11002897640
11006532177
11006532094
11002897111
11006532045
11006532334
11002897616
11006532482
11006532433
11020800279
11023632406
11006531922
11006532383
11012980113
11006532144
11012979933
11000208246
11002897467
11006532995
11000208220
11006532128
11000208014
11020800253
11020800253
11006532805
11026922101
11006532813
11002897145

Nomor Induk
Karyawan
(NIK)

Nama Tenaga Kerja

Tgl Lahir (tgl/bln/thn)

Data Upah
(Rp.)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

2011
Tahun

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

AGUS PRIONO

29 Juli 1983

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

AHMAD SYARIZAL

07 Juni 1984

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

AHMADI DARMA

11 Okt 1984

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ALEK SRIJAYA

19 April 1980

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

ANDI MUHAMMAD ZAIN HALLAWA

20 April 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ANDRE TUA MANULLANG

16 Mei 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ANTONI SYAHPUTRA

25 Nopember 1984

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ARDIMAN ARITONANG

16 Maret 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ARMINTO SINAGA

10 September 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ATOM RIZAL

15 Desember 1960

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

BANGUN SIMANJUNTAK

06 April 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

BARITA HUTAURUK

30 September 1985

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

BELSON SARAGIH

23 Juli 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

BERNAT HUTAGAOL

31 Desember 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

BOLATAN RAJA GUKGUK

18 Februari 2013

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

BONGGEL SIMANGUNSONG

17 Februari 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

BOSIK SAHAT MARTUA

02 Sep 1981

1,600,000

8,640

4,800

30,000

32,000

59,200

134,640

BOSKEN KASTEL PREDI SARAGI

10 Februari 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

BRIDSON H. RAJAGUKGUK

24 April 1967

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

BUDIMAN MANULANG

26 Februari 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

CANDRA HIDAYAT

05 Oktober 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

CANDRA PANGABEAN

16 April 1986

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

CANDRA SIHOMBING

22 Agustus 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

CIMUS

09 Mei 1991

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

DARIANTO

19 Nopember 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

DEDY MASUARDI

12 Januari 1990

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

DEDY WARNATAL ZEBUA

27 Desember 1987

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

DELFANCE W

15 Januari 1991

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

DENSON SIAHAAN

10 Desember 1974

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

DONGAN PANGARIBUAN

17 Agustus 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

EDI LAIA

10 Mei 1985

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

No.

32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67

Nomor KPJ

10021107890
11006532821
11006532474
99C20053301
11000208238
11002897160
11002897178
11002897178
11000208055
11020800220
11016463934
11002897186
11006531906
11006531997
11006532839
11006531955
11006532847
11006532342
11006532425
11002897194
11000208121
11006531872
11012980105
11012980063
11000208212
11026922085
11006531971
11002897202
11012979941
11006532862
11006532870
11006532888
11020800261
11006532169
11006532300
11002897210

Nomor Induk
Karyawan
(NIK)

Nama Tenaga Kerja

Tgl Lahir (tgl/bln/thn)

Data Upah
(Rp.)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

EDI SAPUTRA SIREGAR

14 Agus 1989

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

EDI TAMBUNAN

25 Mei 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

EDISON TUMANGGOR

21 September 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

EDUARD HARIANJA

09 Januari 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

EDWAR JANRI H SITINJAK

08 Januari 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ELISABET

10 Oktober 1982

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ELPIA PANGARIBUAN

28 Mei 1988

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ELPINA SITUMORANG

16 April 1985

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

EPAN SINAGA

28 Agustus 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ERWIN SINAGA

30 Juni 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ERWIN SINAMBELA

10 Juni 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

EVI BR SURBAKTI

21 Agustus 1987

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

FINA LESTARI

09 September 1982

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

FIRDAUS LAIA

25 Agustus 1991

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

FIRMAN DOLOK SARIBU

20 Desember 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

FRENGKI GULTOM

19 Desember 1962

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

GUINES RUMAPEA

13 Juli 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

GUNSONG HARIANJA

26 April 1987

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HAKIMUDDIN SIREGAR

05 Maret 1987

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HANNA MARBUN

12 Februari 1983

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

HARIANTO

16 Agustus 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HARIS SIHOMBING

29 September 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HARYONO

27 April 1971

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

HERLINAWATI SIAHAAN

14 April 1983

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

HERMAWAN

05 Agustus 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HERTA J. MANALU

22 Nopember 1983

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

HISAR SITANGGANG

06 April 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HITLER HASIBUAN

30 Agustus 1972

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HOBBY O SUNGGU

03 Juli 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

HOTMA SILABAN

15 Desember 1968

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

IWAN LAILA

14 Mei 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

J SIAHAAN

29 Desember 1964

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

J. CORNELIUS GINTING

05 Juli 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JAHOPPUL SITOHANG

06 Juli 1972

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JALESDIN FORMEL VANDEN S

11 Juni 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JALIMAN ERIKO PANJAITAN

07 Maret 1978

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

No.

68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103

Nomor KPJ

11000208196
11002897491
11006532896
11006532706
11002897228
11006531831
11002897509
11006532458
11006532714
11006532292
11006531963
11000208154
11000208147
11002897244
11002897632
11002897251
05J50026326
11000208279
11000208048
11006531823
11006531815
11006532466
11006532722
07D10020080
11006532730
11012980139
11026922093
11006532391
11000208352
11002897269
11012980014
11002897517
11006532052
11000208170
11006531880
11006531807

Nomor Induk
Karyawan
(NIK)

Nama Tenaga Kerja

Tgl Lahir (tgl/bln/thn)

Data Upah
(Rp.)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

JANTI NABABAN

11 Februari 1972

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JANTIAGMAN PURBA

26 Nopember 1986

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JELIWANTO SIMBOLON

04 Nopember 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

JETRO GULTOM

06 Juli 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JHON CHEYHEYSER PARAPAT

30 Desember 1965

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JHON PREZER SIMANGUNSONG

20 Agustus 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JONI ANTON SARAGIH

03 Februari 1991

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

JOSUA ERWIN TOGATORAP

15 Februari 1982

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

JOSUA PURBA

27 Nopember 1980

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

JUAN SINAGA

11 April 1976

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

JUDIKA ALEKSANDER HARIANJA

19 Desember 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JUMAIN

29 Januari 1971

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JUMARYANTO

21 Januari 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

JUPINAWATI PERANGIN-ANGIN

29 Juni 1976

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

KAHUAT

27 Maret 1962

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

KAMAL LUBIS

04 Februari 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

KAREL DORMAN SIREGAR

01 Juni 1964

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

LAMBAS SIMARE-MARE

05 September 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LAMHOT SIHOMBING

27 Desember 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LAMHOT SIMANJUNTAK

21 Agustus 1988

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LAMO HASUGIAN

29 Agustus 1984

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LARISMAN SITUMORANG

01 Juli 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LASDON SUFARDI NABABAN

02 Mei 1988

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LASMA ULINA SIDABALOH

09 Februari 1988

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

LASMER SIRAIT

03 Maret 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LELI HASDA JULITA

31 Juli 1979

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

LENAWATI SARI INTAN

12 Marer 1981

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

LENNI TINJAK

06 Juni 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LEONARD PANGGABEAN

25 Januari 1983

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

LISBON SIRAIT

09 Agustus 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

LISNA TINAMBUNAN

04 Mei 1984

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

M RIFALDI SINAGA

22 Agustus 1988

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

M. HAIDIR

10 Maret 1960

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

M. PARDOMUAN ARITONANG

04 Oktober 1952

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MAHRIZAL

08 Oktober 1968

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MANAT SIMATUPANG

31 Januari 1971

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

No.

104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139

Nomor KPJ

11006532748
11000208204
11002897277
11006532151
11002897285
11006532904
11002897293
11006532201
11000208071
11026922069
11006532441
11012980055
11002897301
11000208261
11002897525
11006532060
11006532037
11006532110
11006532912
11002897319
11002897533
11006532219
11006532581
11006532367
11000208386
11006531914
11006532599
11006532284
11006531799
11000208329
11006532318
11006532359
11006532763
11006531781
11006532185
11006532771

Nomor Induk
Karyawan
(NIK)

Nama Tenaga Kerja

Tgl Lahir (tgl/bln/thn)

Data Upah
(Rp.)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

MANGADAR HARIANJA

08 September 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MANGARAN SINAGA

30 Januari 1968

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MARDIANA TRESIA BR GALINGGING 26 April 1988

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

MARIADI

21 Mei 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MARIANA GULTOM

28 Mei 1978

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

MARLON SINAGA

17 Oktober 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MARSIUS MARANDO SIMBOLON

18 Agustus 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MARUBA SITUMORANG

08 Agustus 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MARUDUT SIMANJUNTAK

14 Juni 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MASTER PANJAITAN

11 Juli 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MELATI JUNTAK

01 April 1985

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

MELIKA FORMINA SINAGA

22 Des 1985

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

MESRAWATI SIHOMBING

19 Maret 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MIDUK LOMBAN TOBING

28 Oktober 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MINTER SITORUS

23 Januari 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MISDI

05 Februari 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MUHAMAD EMRY

03 April 1989

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MURIANTO

09 Desember 2015

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MURIONO

13 Juli 1984

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

MURNIDA BR HASIBUAN

18 Desember 1971

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

NADRATUL NAILA

08 Agustus 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

NASIB PAKPAHAN

22 Februari 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

NELSON UDIN SIMANJUNTAK

03 Januari 1982

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

NUR AINUN SARI MARPAUNG

16 Maret 1987

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

NURHAYATI LUBIS

27 Januari 1985

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

OBRIN SILALAHI

19 Agustus 1982

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

P PRODUSMA SILABAN

23 Juli 1967

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

PAMRES SIREGAR

12 Desember 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PANDAPOTAN SIANIPAR

24 Juni 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PARLINDUNGAN SILALAHI

31 Desember 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PATAR PAKPAHAN

02 Juli 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PENDI HOMBING

27 Maret 1974

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

PERIS SITUMORANG

23 Maret 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PERLINDUNGAN TAMBUNAN

08 Oktober 1984

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

PITAHDIM DAMANIK

10 April 1969

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PITER SIANIPAR

18 Aguatus 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

No.

140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175

Nomor KPJ

11002897327
11000208022
11006532490
11002897335
11012979990
11006531989
11000208311
11002897343
11020800238
11012980022
11006532268
11006532789
11002897350
11006532235
11000208253
11002897368
11020800287
11006532326
11006532193
11002897541
11002897376
11006532797
11006531773
11000208097
11012979958
11002897558
11012980006
11002897384
11000208113
11012980089
11002897392
11006532615
11006532623
11002897400
11000208105
11002897418

Nomor Induk
Karyawan
(NIK)

Nama Tenaga Kerja

Tgl Lahir (tgl/bln/thn)

Data Upah
(Rp.)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

PONIJO RAWI

06 April 1972

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PONIMAN

05 Mei 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PRIYAN

01 Juli 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

PRIYANI DALIMONTE

15 Februari 1980

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RACAY MANTO HUTABARAT

04 Okt 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RADIUN SITOMPUL

07 Nopember 1963

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RAMLI

03 Desember 1969

1,500,000

8,100

4,500

60,000

30,000

55,500

158,100

RAPADAN DANAMANIK

21 Mei 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RATAPAN LAIA

13 Mei 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RELYANI PURBA

12 Februari 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

REMON TARIGAN

02 Nopember 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RIKO SIRAIT

01 Januari 1979

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RIMSON SIMATUPANG

12 Juli 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RINALDY JOHNTUA SIMBOLON

28 Februari 1988

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RINGGAS SINAGA

10 Juni 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RINNA ROSMAWATI SITOHANG

28 Agustus 1968

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RISDO HOTMARIA PURBA

22 September 1980

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RITA PURNAMA SIDABALOK

12 Juni 1992

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RIVAI LUMBAN TOBING

21 September 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ROBINHOOT SINAGA

12 Desember 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RODUMA MATONDANG

05 Maret 1977

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ROILIS NABABAN

30 Mei 1986

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RONAL SITANGGANG

31 Desember 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RONALDO HUTAGALUNG

02 Maret 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RONI SIMANJUNTAK

03 Juli 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ROSDIANA BR SIHOMBING

07 Maret 1972

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ROSIHAN ANUAR

22 Mei 1977

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

ROSMAWATI SIGALINGGING

21 Oktober 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ROSMINA HARAHAP

10 Agustus 1972

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ROTAMA MUNTHE

16 Februari 1993

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ROTUA SINAGA

04 Juni 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RUSLI

21 Juli 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

RUSLY

18 Mei 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SADIAH SIMAMORA

15 Mei 1969

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SAHAT LUMBAN TORUAN

31 Desember 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SAHAT SINAGA

20 Agustus 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

No.

176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211

Nomor KPJ

11016463926
11006531765
11006532649
11006532227
11012979974
11006531757
11006532029
11002897566
11006532664
11006531948
11000208089
11006532417
11000208162
11006532011
11002897574
11006532672
11000208394
11002897426
8025955702
11002897582
11006532680
07D00394446
11006532078
11000208139
11020800246
11000208376
11002897434
11000208345
11006532524
11000208030
98D00079657
11006532540
11006531732
11023632398
11006532102
11000208360

Nomor Induk
Karyawan
(NIK)

Nama Tenaga Kerja

Tgl Lahir (tgl/bln/thn)

Data Upah
(Rp.)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

SANGKOT IMMANUEL SIBURIAN

15 Mei 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SARDIAMAN SIMANJUNTAK

13 Februari 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SARDIMAN SINAGA

19 Nopember 1978

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SARIATI SIREGAR

03 Agustus 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SARLON SIHOTANG

22 Juli 1987

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

SARMAN MUNTHE

09 Juni 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SAUL SINAMBELA

14 Juni 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SAUT ABDULLAH SINAGA

17 Desember 1977

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SAUTLAN PURBA

24 September 1965

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SIMON PARTOMUAN

06 Maret 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SITI KADIJAH

05 Januari 1985

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

SITI NURHALIMA PASARIBU

26 Mei 1990

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

SLAMAT SIHOMBING

10 Oktober 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SONNY DAMAY LASE

05 Nopember 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SOPAR SITOMPUL

06 Nopember 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SUBROTO

14 April 1974

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SUMIATUN

27 April 1977

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

SUNARNO

28 Agustus 1969

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SURATMAN

21 Januari 1974

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SUSANTO

17 Juli 1980

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SUTIO ONIWATI

25 Oktober 1963

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SUWARDI MANULLANG

31 Agustus 1986

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SYAHYUDI

23 Desember 1990

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TAMARUDDIN

01 Juli 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TANGGIAT PAKPAHAN

22 Maret 1976

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TARUBAR MANURUNG

25 Mei 1981

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

TIAMBUN ARITONANG

21 Nopember 1977

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

TIMBUL REVLON ARITONANG

28 September 1979

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TOGAP LUMBAN RAJA

11 Maret 1984

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TOGAR PANJAITAN

12 Januari 1973

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TOHARI

01 Februari 1973

1,700,000

9,180

5,100

60,000

34,000

62,900

171,180

TOLUS SINAGA

03 September 1982

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TONNI NAINGGOLAN

04 Juli 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

TUGINO

23 Februari 1979

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

TUKIMAN

02 April 1967

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

UDUR M. SINAGA

14 Maret 1986

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

No.

212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231

Nomor KPJ

Nomor Induk
Karyawan
(NIK)

11002897608
11006532565
11002897442
11006532573
11006607060
11006531898
11006607078
11006532086
11000208287
11030793852
11030793860
11030793878
11030793886
11030793894
11034285525
11034285533
7009112546
07D00198813
11034285541
7009112736

Nama Tenaga Kerja

Data Upah
(Rp.)

Tgl Lahir (tgl/bln/thn)

Iuran JKK
(Rp.)

Iuran JKM
(Rp.)

Iuran JPK
(Rp.)

Iuran JHT TK
(Rp.)

Iuran JHT
Perusahaan
(Rp.)

Total Iuran
(Rp.)

UMBU IWAN LASE

20 Juli 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

VALDY ARITONANG

18 Agustus 1989

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

WAGINO

10 Februari 1975

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

WALSON SITANGGANG

26 Agustus 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

WIDIYA ASTUTI

26 Juli 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

WIDIYANTO DL

23 Juli 1964

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

WINARDY

14 Oktober 1982

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

WINDARMAN

05 April 1981

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

YOEDI HALAWA

24 April 1983

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

ESRIANTO SINAMO

29 Maret 1989

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

RIKARDO TAMBA

04 Januari 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

HISAR RAJAGUKGUK

14 Desember 1970

1,150,000

6,210

3,450

60,000

23,000

42,550

135,210

SOPIAN DALIMA TELAUMBANUA

27 Juni 1989

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

SETIO BURYANTO

15 Maret 1977

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

MAYAWATI

11 Juli 1989

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

LIDIA NATALIA SINAGA

18 September 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ELFAN ZALFIANDHI

20 Februari 1976

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

SYAMSUHADI

19 Februari 1981

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

WAHYU

07 Maret 1971

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

FIRMAN PANJAITAN

30 April 1974

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

232

233

234

235

5,466,000

10,112,100

29,873,820

Jumlah Seluruhnya

273,300,000

Keterangan :

1,475,820

819,900

12,000,000

Pekan Baru, 07 Desember 2011

1. Isian formulir ini dapat disampaikan kepada PT. Jamsostek (Persero) dalam bentuk media elektronik (softcopy) ataupun hasil cetakan dari
sistem penggajian perusahaan peserta yang bersangkutan, dengan format yang sama.
2. Untuk iuran lanjutan hanya diisi untuk :
1. Tenaga kerja peserta baru.
2. Tenaga kerja yang mengalami perubahan upah dan penambahan program.

Leli Hasda Julita

Ka. Personalia

239

30,000

30,000

30,000

30,000

30,000

30,000

30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
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30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
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30,000 #REF!
30,000 #REF!
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30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
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30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
30,000 #REF!
60,000

60,000

60,000

60,000

60,000

60,000

60,000

60,000

60,000

60,000

10

60,000

11

60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

40

60,000

41

60,000

42

60,000

43

60,000

44

60,000

45

60,000

46

60,000

47

60,000

48

60,000

49

60,000

50

60,000

51

60,000

52

60,000

53

60,000

54

60,000

55

60,000

56

60,000

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60,000

58

60,000

59

60,000

60

60,000

61

60,000

62

60,000

63

60,000

64

60,000

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60,000

66

60,000

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60,000

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60,000

69

60,000

70

60,000

71

60,000

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60,000

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60,000

74

60,000

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60,000

76

60,000

77

60,000

78

60,000

79

60,000

80

60,000

81

60,000

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60,000

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60,000

84

60,000

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60,000

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60,000

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60,000

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60,000

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60,000

90

60,000

91

60,000

92

60,000

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60,000

94

60,000

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60,000

96

60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

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60,000

128

60,000

129

60,000

130

60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!

60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
60,000 #REF!
#REF!
#REF!
#REF!

Formulir
Jamsostek
2a

RINCIAN IURAN TENAGA KERJA

NPP
DD 003500
Nomor KPJ

Nama Perusahaan
Riau Agung Karya Abadi PT
Nomor Induk
Karyawan (N I K )

Nama Unit Kerja

Kebun Libo & Kantor Direksi
Tgl Lahir
(tgl/bulan/tahun)

Nama Tenaga Kerja

Data Upah
(Rp)

Iuran JKK
(Rp)

Iuran JKM
(Rp)

Iuran JPK
(Rp)

Iuran JHT TK
(Rp)

Iuran JHT TK
Perusahaan (Rp)

Total Iuran
(Rp)

MAYAWATI

11 Juli 1989

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

LIDIA NATALIA SINAGA

18 September 1986

1,150,000

6,210

3,450

30,000

23,000

42,550

105,210

ELFAN ZALFIANDHI

20 Februari 1976

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

SYAMSUHADI

19 Februari 1981

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

WAHYU

07 Maret 1971

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

1,600,000

8,640

4,800

60,000

32,000

59,200

164,640

FIRMAN PANJAITAN

Jumlah seluruhnya

8,700,000

46,980

26,100

300,000

174,000

321,900

Keterangan :
Pekan Baru, 07 Desember 2011

1. Isian formulir ini dapat disampaikan kepada PT. Jamsostek (Persero) dalam bentuk media elektronik (softcopy) ataupun hasil cetakan dari
sistem penggajian perusahaan peserta yang bersangkutan, dengan format yang sama.
2. Untuk iuran lanjutan hanya diisi untuk :
1. Tenaga kerja peserta baru
2. Tenaga kerja yang mengalami perubahan upah dan penambahan program

Leli Hasda Julita

Ka. Personalia

868,980

msostek