ACCOUNT STATEMENT

KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA

MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 1

Journa
Posting Date Effective Date Branch Transaction Description Amount
l
Ledger Balance: TRANSFER DARI |
15/10/2018 15/10/2018 43517 PEMINDAHAN DARI
Unit E- 1,154,396.00
04.10.12 04.10.12 7 774360289411003 | KLINIK
Banking
SURYA MEDIKA MBL |
OTOPAY KK 15/10/18
208065565 |
0000000489374593
TRANSFER KE |
15/10/2018 15/10/2018 DIVISI 05103 0000000000000000
PEMINDAHAN KE
151018011534 659,571.00
10.41.21 10.41.21 TRANSAC 7 760360200001004 | PT
TIONAL KIMIA FARMA | pembayaran
BANKING faktur obat
SERVICES
(TBS) TRANSFER KE |
15/10/2018 15/10/2018 DIVISI 05103 PEMINDAHAN KE
5,000.00
10.41.21 10.41.21 TRANSAC 7 760360420803001 | PT
TIONAL KIMIA FARMA | pembayaran
BANKING faktur obat
SERVICES
(TBS)
15/10/2018 15/10/2018 32111 SETOR TUNAI | KEU UMM | 117,600,000.
MALANG DANA RENOVASI RS
15.09.29 15.09.29 7 00
15/10/2018 15/10/2018 SUMBAWA DARI |
TRANSFER
JAKARTA 45895 18,000,000.0
15.18.33 15.18.33 8 PEMINDAHAN DARI 0
PUSAT
789111555 SIMSEM RETUR
BNI DIRECT-ID | R/N BD,
DARMO | 0489374593 Retur
16/10/2018 16/10/2018 Trx LLG Tgl KE
90666 TRANSFER 12/10/2018
|
DIVISI 1,200,000.00
08.18.27 08.18.27 5 PEMINDAHAN KE
TRANSAC
191119880 Sdr YOGI
TIONAL
TRIATMAKUSUMA |
BANKING
pembayaran akomodasi &
SERVICES
transportasi perjalanan din
(TBS)
 DIVISI
TRANSAC
TIONAL
BANKING
SERVICES
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 91034 PEMINDAHAN KE
1,896,000.00
08.29.30 08.29.30 TRANSAC 0 191119880 Sdr YOGI
TIONAL TRIATMAKUSUMA |
BANKING penggantian kelebihan
SERVICES pnggunaan dana perjalanan
(TBS) di
TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 94602 PEMINDAHAN KE
578,138.00
09.56.54 09.56.54 TRANSAC 4 109378195 IMMORTAL
TIONAL COSMEDIKA INDON |
BANKING pembayaran bhp skincare
produk immortal TRF

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 2

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

SERVICES TO:00
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05358 PEMINDAHAN KE
3,120,390.00
09.56.54 09.56.54 TRANSAC 2 760360200001004 | edi
TIONAL mulyono gunawan |
BANKING pembayaran bhp skincare
SERVICES produk kitoderm
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05358 PEMINDAHAN KE
5,000.00
09.56.54 09.56.54 TRANSAC 2 760360420803001 | edi
TIONAL mulyono gunawan |
BANKING pembayaran bhp skincare
SERVICES produk kitoderm
(TBS)
 DIVISI
TRANSAC
TIONAL
BANKING
SERVICES
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05358 PEMINDAHAN KE
718,427.00
09.56.54 09.56.54 TRANSAC 3 760360200001004 |
TIONAL yustinus joko mulyantor |
BANKING pembayaran bhp skincare
SERVICES produk geneva
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05358 PEMINDAHAN KE
5,000.00
09.56.54 09.56.54 TRANSAC 3 760360420803001 |
TIONAL yustinus joko mulyantor |
BANKING pembayaran bhp skincare
SERVICES produk geneva
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05380 PEMINDAHAN KE
5,636,600.00
09.56.55 09.56.55 TRANSAC 9 760360200001004 | arini
TIONAL prabowo ac | pembayaran
BANKING bhp skincare produk be-
SERVICES white
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05380 PEMINDAHAN KE
5,000.00
09.56.55 09.56.55 TRANSAC 9 760360420803001 | arini
TIONAL prabowo ac | pembayaran
BANKING bhp skincare produk be-
SERVICES white
(TBS)
16/10/2018 16/10/2018 DIVISI 94603 TRANSFER KE |
PEMINDAHAN KE 2,100,000.00
09.56.55 09.56.55 TRANSAC 1
575859604 Bpk DIMAS
TIONAL
PERDANA | pembayaran bhp

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 3
 Journa
Posting Date Effective Date Branch Transaction Description Amount
l

BANKING skincare produk raditya TRF

SERVICES TO:0000
(TBS) TRANSFER KE |
16/10/2018 16/10/2018 DIVISI 05383 PEMINDAHAN KE
2,222,300.00
09.56.55 09.56.55 TRANSAC 2 760360200001004 |
TIONAL PT.KITOSHINDO INTERNASI
BANKING NAL BIOTECH | pembayaran
SERVICES bhp skincare produk
(TBS) kitoderm KE |
TRANSFER
16/10/2018 16/10/2018 DIVISI 05383 PEMINDAHAN KE
5,000.00
09.56.55 09.56.55 TRANSAC 2 760360420803001 |
TIONAL PT.KITOSHINDO INTERNASI
BANKING NAL BIOTECH | pembayaran
SERVICES bhp skincare produk
(TBS) kitoderm DARI |
TRANSFER
16/10/2018 16/10/2018 DIVISI 37185 PEMINDAHAN DARI
246,000.00
10.18.20 10.18.20 TRANSAC 2 119352653 BNI LIFE
TIONAL INSURANCE, PT |
BANKING 0489374593
SERVICES 201810161486942179 |
(TBS) B.5/183/KLINIK_SMS/IV/18-
16/10/2018 16/10/2018 27373 PK-R |004166.TIK.IH3 13,190,000.0
MALANG SETOR TUNAI | UMM
11.02.35 11.02.35 1 0
16/10/2018 16/10/2018 DIVISI 98192 TRANSFER KE | 13,190,000.0
15.03.21 15.03.21 1 PEMINDAHAN KE 0
TRANSAC
191119880 Sdr YOGI
TIONAL
TRIATMAKUSUMA |
BANKING
pengantian dana byr tiket
SERVICES
psawat & hotel prjalanan
(TBS)
16/10/2018 16/10/2018 DIVISI 35397 KREDIT LAIN-LAIN | 008 PLN
261,391.00
15.46.59 15.46.59 OPERASI 4 DISJATIM PLN DIST JATIM
TRANSFER DARI |
ONAL
17/10/2018 17/10/2018 Unit E- 40202 PEMINDAHAN DARI
774360289401025 | KLINIK 499,250.00
04.09.15 04.09.15 Banking 1
SURYA MEDIKA MBL |
OTOPAY KD 17/10/18
208065565 |
0000000489374593
TRANSFER KE |
17/10/2018 17/10/2018 DIVISI 55038 0000000000000000
PEMINDAHAN KE 18,000,000.0
08.45.25 08.45.25 5 171018004044 0
TRANSAC 760360200001004 |
TIONAL ESTETIKA PRO INTERNATIO
BANKING AL | pembayaran alat
skincare
 ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 4

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

SERVICES
(TBS) TRANSFER KE |
17/10/2018 17/10/2018 DIVISI 55038 PEMINDAHAN KE
5,000.00
08.45.25 08.45.25 TRANSAC 5 760360420803001 |
TIONAL ESTETIKA PRO INTERNATIO
BANKING AL | pembayaran alat
SERVICES skincare
(TBS) TRANSFER DARI |
17/10/2018 17/10/2018 DIVISI 31738 PEMINDAHAN DARI
857,750.00
11.02.39 11.02.39 TRANSAC 0 119352653 BNI LIFE
TIONAL INSURANCE, PT |
BANKING 0489374593
SERVICES 20181017859103632 |
(TBS) B.5/196/KLINIK-SMS/IV/18-PK
TRANSFER DARI |
17/10/2018 17/10/2018 DIVISI 51710 PEMINDAHAN
|004187.TIK.IH3
DARI 125,939.00
14.01.45 14.01.45 TRANSAC 1 119352653 BNI LIFE
TIONAL INSURANCE, PT |
BANKING 0489374593
SERVICES 201810171838302669 |
(TBS) B5/183/KLINIK-SMS/IV
TRANSFER DARI |
17/10/2018 17/10/2018 JAKARTA 59847 PEMINDAHAN
|4198-INT13 DARI 3,120,390.00
16.51.23 16.51.23 PUSAT 3 789111555 SIMSEM RETUR
BNI DIRECT-ID | R/NB, edi
mulyono gunawan |
0489374593
TRANSFER Retur
DARI | Trx LLG
17/10/2018 17/10/2018 JAKARTA 59850 PEMINDAHAN
Tgl 16/10/2018DARI 5,636,600.00
16.51.23 16.51.23 PUSAT 5 789111555 SIMSEM RETUR
BNI DIRECT-ID | R/NB, arini
prabowo ac | 0489374593
Retur Trx LLG Tgl
16/10/2018
 TRANSFER KE |
18/10/2018 18/10/2018 DIVISI 54589 PEMINDAHAN KE
7,721,667.00
08.41.08 08.41.08 TRANSAC 9 760360200001004 | PT.
TIONAL PRODIA WIDYAHUSADA bk |
BANKING pembayaran pendapatan
SERVICES prodia
(TBS) TRANSFER KE |
18/10/2018 18/10/2018 DIVISI 54589 PEMINDAHAN KE
5,000.00
08.41.08 08.41.08 TRANSAC 9 760360420803001 | PT.
TIONAL PRODIA WIDYAHUSADA bk |
BANKING pembayaran pendapatan
SERVICES prodia

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 5

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

(TBS) TRANSFER KE |
18/10/2018 18/10/2018 DIVISI 54590 PEMINDAHAN KE
3,120,390.00
08.41.08 08.41.08 TRANSAC 3 760360200001004 | edy
TIONAL muliono gonawan |
BANKING pembayaran skincare
SERVICES produk kitoderm
(TBS) TRANSFER KE |
18/10/2018 18/10/2018 DIVISI 54590 PEMINDAHAN KE
5,000.00
08.41.08 08.41.08 TRANSAC 3 760360420803001 | edy
TIONAL muliono gonawan |
BANKING pembayaran skincare
SERVICES produk kitoderm
(TBS)
 18/10/2018 18/10/2018 DIVISI 54600 TRANSFER KE |
PEMINDAHAN KE 5,636,600.00
08.41.08 08.41.08 TRANSAC 5
760360200001004 | arini
TIONAL
prawono | pembayaran
BANKING
skincare produk be-white
SERVICES
(TBS)
18/10/2018 18/10/2018 DIVISI 54600 TRANSFER KE |
PEMINDAHAN KE 5,000.00
08.41.08 08.41.08 TRANSAC 5
760360420803001 | arini
TIONAL
prawono | pembayaran
BANKING
skincare produk be-white
SERVICES
(TBS)
18/10/2018 18/10/2018 DIVISI 90297 TRANSFER KE | pembayaran
08.56.34 08.56.34 2 lampu bistro | PEMINDAHAN 1,058,886.00
TRANSAC
KE 8606006008
TIONAL
TOKOPEDIA |
BANKING
8277082244451138 TKP
SERVICES
eko saputro
(TBS) TRANSFER KE | pembayaran
18/10/2018 18/10/2018 DIVISI 90298 alat non medis sprei,masker
1,950,800.00
08.56.35 08.56.35 TRANSAC 0 set , handu | PEMINDAHAN
TIONAL KE 8606006008
BANKING TOKOPEDIA |
SERVICES 8277081805222016 TKP
(TBS) Enda
18/10/2018 18/10/2018 DIVISI 51419 KREDIT LAIN-LAIN | 008
ASURANSI JIWA I 8,590,793.00
09.36.04 09.36.04 OPERASI 2
B.5/213/KLINIK_SMS/
ONAL
IV/2018

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 6
 Journa
Posting Date Effective Date Branch Transaction Description Amount
l
PERGURU
18/10/2018 18/10/2018 AN 44089 50,000,000.0
SETOR TUNAI | PT OPI
10.23.39 10.23.39 TINGGI 1 0
BANDUN
18/10/2018 18/10/2018 G
DIVISI 51870 TRANSFER KE | 30,972,500.0
10.29.14 10.29.14 6 PEMINDAHAN KE 0
TRANSAC
760360200001004 | MEKAR
TIONAL
SARI CV/BUDI KARY NTO |
BANKING
pembayaran 50% renovasi
SERVICES
pembangunan
(TBS)
18/10/2018 18/10/2018 DIVISI 51870 TRANSFER KE |
PEMINDAHAN KE 5,000.00
10.29.14 10.29.14 TRANSAC 6
760360420803001 | MEKAR
TIONAL
SARI CV/BUDI KARY NTO |
BANKING
pembayaran 50% renovasi
SERVICES
pembangunan
TRANSFER DARI |
(TBS)
19/10/2018 19/10/2018 41183 PEMINDAHAN DARI
Unit E- 46,060.00
04.07.59 04.07.59 4 774360289411003 | KLINIK
Banking
SURYA MEDIKA MBL |
OTOPAY KK 18/10/18
208065565 |
0000000489374593
19/10/2018 19/10/2018 DIVISI 99552 0000000000000000
TRANSFER KE |
181018011820
PEMINDAHAN KE 1,834,140.00
09.18.31 09.18.31 TRANSAC 5
345972600 RIDHO ILAHI
TIONAL
FARMA, PT | PEMBAYARAN
BANKING
FAKTUR OBAT NO FAKTUR
SERVICES
RIF0918-006985 T
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 99552 PEMINDAHAN KE
6,931,120.00
09.18.31 09.18.31 TRANSAC 6 1322620159 PT TRI SAPTA
TIONAL JAYA | pembayaran faktur
BANKING obat NO FAKTUR
SERVICES 011520,013124,012
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 35361 PEMINDAHAN KE 25,298,790.0
09.18.31 09.18.31 TRANSAC 0 760360200001004 | PT 0
TIONAL BINA SAN PRIMA |
BANKING pembayaran faktur obat no
SERVICES faktur fkmtr/201809/0135
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 35361 PEMINDAHAN KE
TRANSAC 5,000.00
09.18.31 09.18.31 0 760360420803001 | PT
TI
BINA
 ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 7

Journa
Posting Date Effective Date Branch Transaction Description Amount
l
SAN PRIMA | pembayaran
ONAL
faktur obat no faktur
BANKING
fkmtr/201809/0135
SERVICES
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 99553 PEMINDAHAN KE 13,513,542.0
09.18.31 09.18.31 TRANSAC 5 2013599991 PT MURNI AIK 0
TIONAL SUKSES | pembayaran
BANKING faktur obat NO FAKTUR MAS-
SERVICES 1809-000340,0
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 35378 PEMINDAHAN KE
364,320.00
09.18.31 09.18.31 TRANSAC 4 760360200001004 | PT.
TIONAL TEMPO | pembayaran faktur
BANKING obat
SERVICES
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 35378 PEMINDAHAN KE
5,000.00
09.18.31 09.18.31 TRANSAC 4 760360420803001 | PT.
TIONAL TEMPO | pembayaran faktur
BANKING obat
SERVICES
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 35379 PEMINDAHAN KE
6,427,025.00
09.18.31 09.18.31 TRANSAC 1 760360200001004 | pt
TIONAL penta valent | pembayaran
BANKING faktur obat no faktur 0147-
SERVICES AR-18-000114
(TBS) TRANSFER KE |
19/10/2018 19/10/2018 DIVISI 35379 PEMINDAHAN KE
5,000.00
09.18.31 09.18.31 TRANSAC 1 760360420803001 | pt
TIONAL penta valent | pembayaran
BANKING faktur obat no faktur 0147-
SERVICES AR-18-000114
(TBS)
 TRANSFER KE |
DIVISI PEMINDAHAN KE
TRANSAC 760360420803001 | pt
TIONAL penta valent | pembayaran
BANKING faktur obat no faktur 0147-
SERVICES AR-18-000114
(TBS)
19/10/2018 19/10/2018 DIVISI 99715 TRANSFER KE | pembayaran
bhp non medis skincare 974,000.00
09.22.29 09.22.29 TRANSAC 2
spons | PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001017870 AirPay
(TBS)
19/10/2018 19/10/2018 19167 for Sho-Klinik
TRANSFER surya
DARI | me
DIVISI 9,078,385.00
15.25.36 15.25.36 9 PEMINDAHAN

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 8

Journa
Posting Date Effective Date Branch Transaction Description Amount
l
DARI 119352653 BNI LIFE
TRANSAC
INSURANCE, PT | I DEWA
TIONAL
GEDE WIANTARA | ANGGA
BANKING
WIRAWAN |
SERVICES
4235-INT7 | 0489374593
(TBS)
20/10/2018 20/10/2018 20181019655682421
96826 TRANSFER KE | pembelian
DIVISI 157,000.00
08.16.55 08.16.55 0 bhp skincare selimut 1 |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001020066 AirPay
(TBS)
20/10/2018 20/10/2018 for Shopee-UCI
96826 TRANSFER KHAIRIAH
KE | pembayaran
DIVISI 157,000.00
08.16.55 08.16.55 1 bhp skincare selimut 5 |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001019495 AirPay
(TBS)
for Shopee-UCI KHAIRIAH
 TRANSFER KE | pembayaran
DIVISI
bhp skincare selimut 5 |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001019495 AirPay
(TBS)
20/10/2018 20/10/2018 96826 for Shopee-UCI
TRANSFER KHAIRIAH
KE | pembayaran
DIVISI 157,000.00
08.16.56 08.16.56 2 bhp skincare selimut 3 |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001019296 AirPay
(TBS)
20/10/2018 20/10/2018 96826 for Shopee-UCI
TRANSFER KHAIRIAH
KE | pembayaran
DIVISI 157,000.00
08.16.56 08.16.56 6 bhp skincare selimut 2 |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001019870 AirPay
(TBS)
20/10/2018 20/10/2018 96826 for Shopee-UCI
TRANSFER KHAIRIAH
KE | pembayaran
DIVISI 157,000.00
08.16.56 08.16.56 7 bhp skincare 4 |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001019676 AirPay
(TBS) TRANSFER KE |
20/10/2018 20/10/2018 94825 for Shopee-UCI KHAIRIAH
DIVISI PEMINDAHAN KE 1,000,000.00
12.06.05 12.06.05 TRANSAC 6 705953248 Sdr ANDI
TIONAL HAMKA ASIS | pembayaran
BANKING gaji THL TRF
SERVICES TO:000000000705953248
(TBS)

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 9
 Journa
Posting Date Effective Date Branch Transaction Description Amount
l
TRANSFER KE |
20/10/2018 20/10/2018 DIVISI 94879 PEMINDAHAN KE
1,000,000.00
12.07.38 12.07.38 TRANSAC 3 714437905 Sdr FANDY DWI
TIONAL SAPUTRA | pembayaran gaji
BANKING THL TRF
SERVICES TO:000000000714437905
(TBS) TRANSFER KE |
20/10/2018 20/10/2018 DIVISI 94929 PEMINDAHAN KE
1,000,000.00
12.09.02 12.09.02 TRANSAC 0 215257216 Sdr FAHMI
TIONAL SAOGI ALJUFRIE |
BANKING pembayaran gaji THL TRF
SERVICES TO:000000000215257216
(TBS)
20/10/2018 20/10/2018 DIVISI 94988 TRANSFER KE |
PEMINDAHAN KE 1,000,000.00
12.10.32 12.10.32 TRANSAC 7
706353375 Ibu YULIAH |
TIONAL
pembayaran gaji THL TRF
BANKING
TO:000000000706353375
SERVICES
TRANSFER DARI |
(TBS)
21/10/2018 21/10/2018 Unit E- 50989 PEMINDAHAN DARI
774360289401025 | KLINIK 416,795.00
04.23.50 04.23.50 Banking 2
SURYA MEDIKA MBL |
OTOPAY KD 21/10/18
208065565 |
0000000489374593
TRANSFER DARI |
22/10/2018 22/10/2018 DIVISI 01301 0000000000000000
PEMINDAHAN DARI
211018004020 1,009,653.00
11.28.28 11.28.28 TRANSAC 6 119352653 BNI LIFE
TIONAL INSURANCE, PT |
BANKING 0489374593
SERVICES 20181022857332711 |
(TBS) B5/196/KLINIKSMS/IV
23/10/2018 23/10/2018 DIVISI 91500 TRANSFER KE | tiket
|4253-INT13
pesawat perjalanan dinas 437,500.00
11.15.49 11.15.49 TRANSAC 6
ke mataram | PEMINDAHAN
TIONAL
KE 536533053 GLOBAL
BANKING
TIKET NETWORK |
SERVICES
8319001000225559
(TBS) TRANSFER KE | tiket
23/10/2018 23/10/2018 DIVISI 94607 Tiket.com-alifudin alifudin
pesawat perjalanan dinas 437,500.00
12.16.48 12.16.48 TRANSAC 2 mataram | PEMINDAHAN KE
TIONAL 536533053 GLOBAL
BANKING TIKET NETWORK |
SERVICES 8319001000225899
Tiket.com-uci
 ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 10

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

(TBS) khairiah
TRANSFER KE |
23/10/2018 23/10/2018 DIVISI 91291 PEMINDAHAN KE 1,053,691.00
14.56.40 14.56.40 TRANSAC 0 7998799867 TRINUSA
TIONAL TRAVELINDO | pembayaran
BANKING tiket pesawat plg perjalanan
SERVICES dinas mat
TRANSFER DARI |
(TBS)
24/10/2018 24/10/2018 Unit E- 45779 PEMINDAHAN DARI
774360289401025 | KLINIK 3,217,807.00
04.11.00 04.11.00 Banking 1
SURYA MEDIKA MBL |
OTOPAY KD 24/10/18
208065565 |
0000000489374593
24/10/2018 24/10/2018 14792 0000000000000000
SETOR TUNAI | PRODIA
MATARAM 241018004031
TRANSFER DARI | 514,000.00
13.35.21 13.35.21 5 WIDYAHUSADA TBK
25/10/2018 25/10/2018 52496 PEMINDAHAN DARI
Unit E- 2,289,471.00
04.18.02 04.18.02 0 774360289401025 | KLINIK
Banking
SURYA MEDIKA MBL |
OTOPAY KD 25/10/18
208065565 |
0000000489374593
25/10/2018 25/10/2018 DIVISI 24717 0000000000000000
TRANSFER KE |
251018005858
PEMINDAHAN KE 2,125,000.00
09.19.14 09.19.14 TRANSAC 6
760360200001004 | ukon
TIONAL
purkonudin | DP paper bag
BANKING
skincare
SERVICES
(TBS)
25/10/2018 25/10/2018 DIVISI 24717 TRANSFER KE |
PEMINDAHAN KE 5,000.00
09.19.14 09.19.14 TRANSAC 6
760360420803001 | ukon
TIONAL
purkonudin | DP paper bag
BANKING
skincare
SERVICES
(TBS)
 TRANSFER KE |
DIVISI
PEMINDAHAN KE
TRANSAC
760360420803001 | ukon
TIONAL
purkonudin | DP paper bag
BANKING
skincare
SERVICES
(TBS) TRANSFER KE |
25/10/2018 25/10/2018 DIVISI 96385 PEMINDAHAN KE 10,000,000.0
13.45.55 13.45.55 TRANSAC 0 447903527 Ibu UCI 0
TIONAL KHAIRIAH | tambahan
BANKING pembelian bhp skincare &
SERVICES bistro TRF TO:0
(TBS)
25/10/2018 25/10/2018 73740 TRANSFER DARI |
MATARAM PEMINDAHAN DARI 2,857,593.00
16.37.45 16.37.45 5
3800063094 SIMSEM GIRO

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 11

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

INTERNAL KLIRI | RESTITUSI

KESEHATAN APRIL DAN MEI
2018
25/10/2018 25/10/2018 02412 TRANSFER DARI | 28,949,829.0
MATARAM PEMINDAHAN DARI
16.41.38 16.41.38 1 0
3800063094 SIMSEM GIRO
INTERNAL KLIRI | RESTITUSI
KESEHATAN AGUSTUS DAN
26/10/2018 26/10/2018 SEPTEMBER 2018
SUMBAW 75477 SETOR TUNAI | WARSITO 35,000,000.0
08.25.52 08.25.52 A BESAR 2 TRANSFER KE | 0
26/10/2018 26/10/2018 DIVISI 92397 PEMINDAHAN KE 95,849,500.0
09.05.28 09.05.28 TRANSAC 4 575859604 Bpk DIMAS 0
TIONAL PERDANA | pelusan alat
BANKING skincare pt raditya TRF
SERVICES TO:000000000
(TBS)
 TRANSFER KE |
DIVISI PEMINDAHAN KE
TRANSAC 575859604 Bpk DIMAS
TIONAL PERDANA | pelusan alat
BANKING skincare pt raditya TRF
SERVICES TO:000000000
(TBS)
26/10/2018 26/10/2018 DIVISI 51205 TRANSFER KE |
PEMINDAHAN KE 936,080.00
09.42.26 09.42.26 TRANSAC 0
760360200001004 | PT
TIONAL
MITRA MEDITAMA ABADI |
BANKING
pembayaran bhp apotek
SERVICES
(TBS)
26/10/2018 26/10/2018 DIVISI 51205 TRANSFER KE |
PEMINDAHAN KE 5,000.00
09.42.26 09.42.26 TRANSAC 0
760360420803001 | PT
TIONAL
MITRA MEDITAMA ABADI |
BANKING
pembayaran bhp apotek
SERVICES
(TBS)
26/10/2018 26/10/2018 DIVISI 59820 KREDIT LAIN-LAIN | 008
ASURANSI JIWA I 4,022,705.00
10.28.30 10.28.30 OPERASI 5
B.5/220/Klinik_SMS/
ONAL
26/10/2018 26/10/2018 DIVISI 59823 KREDIT
IV/2018 LAIN-LAIN | 008
ASURANSI JIWA I 168,391.00
10.28.30 10.28.30 OPERASI 0
B.5/220/Klinik_SMS/
ONAL
26/10/2018 26/10/2018 DIVISI 03938 IV/2018
KREDIT LAIN-LAIN | 008 2,914,871.00
12.54.50 12.54.50 OPERASI 4 ASURANSI JASA I RETUR
ONAL 19/09/2018KE |RETUR
TRANSFER 19/
pembayaran
27/10/2018 27/10/2018 DIVISI 99316 bhp skincare pisau cukur |
167,000.00
09.08.42 09.08.42 TRANSAC 2 PEMINDAHAN KE
TIONAL 613946543 AIRPAY
BANKING INTERNATIONAL IND |
SERVICES 8287001001406228 AirPay
for

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 12
 Journa
Posting Date Effective Date Branch Transaction Description Amount
l

(TBS) Sho-Klinik surya me

27/10/2018 27/10/2018 DIVISI 99316 TRANSFER KE | pembayaran
972,000.00
09.08.45 09.08.45 TRANSAC 5 bhp skincare | PEMINDAHAN
TIONAL KE 613946543 AIRPAY
BANKING INTERNATIONAL IND |
SERVICES 8287001001408767 AirPay
TRANSFER DARI |
(TBS) for Sho-dr. Enda Athiya
28/10/2018 28/10/2018 50629 PEMINDAHAN DARI
Unit E- 711,731.00
04.21.40 04.21.40 3 774360289401025 | KLINIK
Banking
SURYA MEDIKA MBL |
OTOPAY KD 28/10/18
208065565 |
0000000489374593
TRANSFER DARI |
29/10/2018 29/10/2018 0000000000000000
INTERNET 97971 PEMINDAHAN DARI 10,000,000.0
11.22.06 11.22.06 3 281018010948 0
BANKING 456474879 Sdri RATU
ASHRI MAULINA F |
Pembayaran jasa
pemeriksaan dan
29/10/2018 29/10/2018 DIVISI 90745 TRANSFER KE | pembayaran
pengobatan PLN
alat pres kemasan cream | 172,999.00
12.20.06 12.20.06 TRANSAC 4
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
BANKING
INTERNATIONAL IND |
SERVICES
8287001001552872 AirPay
(TBS) TRANSFER KE |
29/10/2018 29/10/2018 DIVISI 93211 for Sho-Klinik surya me
PEMINDAHAN KE 4,636,353.00
13.13.37 13.13.37 TRANSAC 3 191119880 Sdr YOGI
TIONAL TRIATMAKUSUMA |
BANKING pengembalian kelebihan
SERVICES penggunaan dana jakarta
(TBS) ke
29/10/2018 29/10/2018 10148 SETOR TUNAI | PRODIA
MATARAM TRANSFER DARI | 1,005,000.00
14.12.01 14.12.01 9 WIDYAHUSADA TBK
30/10/2018 30/10/2018 47050 PEMINDAHAN DARI
Unit E- 328,901.00
04.20.37 04.20.37 3 774360289401025 | KLINIK
Banking
SURYA MEDIKA MBL |
OTOPAY KD 30/10/18
208065565 |
0000000489374593
30/10/2018 30/10/2018 0000000000000000
97509 TRANSFER KE | pembayaran
DIVISI 132,750.00
09.37.11 09.37.11 4 301018005236
bandana skincare |
TRANSAC
PEMINDAHAN KE
TIONAL
613946543 AIRPAY
 ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 13

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

BANKING INTERNATIONAL IND |

SERVICES 8287001001595814 AirPay
(TBS) for Sho-dr. Enda
TRANSFER KE | Athiya
30/10/2018 30/10/2018 DIVISI 97510 PEMINDAHAN KE
1,011,560.00
09.37.12 09.37.12 TRANSAC 1 109378195 IMMORTAL
TIONAL COSMEDIKA INDON |
BANKING pembayaran cream
SERVICES immortal TRF
(TBS) TO:0000000001093781
TRANSFER KE |
30/10/2018 30/10/2018 DIVISI 99306 PEMINDAHAN KE 10,419,376.0
10.12.57 10.12.57 TRANSAC 3 2013599991 PT MURNI AIK 0
TIONAL SUKSES | pembayaran
BANKING faktur obat no faktur mas-
SERVICES 1809-000209 T
(TBS)
30/10/2018 30/10/2018 DIVISI 68449 TRANSFER KE | 15,570,610.0
10.12.57 10.12.57 1 PEMINDAHAN KE 0
TRANSAC
760360200001004 | PT
TIONAL
BINA SAN PRIMA |
BANKING
pembayaran faktur obat
SERVICES
(TBS)
30/10/2018 30/10/2018 DIVISI 68449 TRANSFER KE |
PEMINDAHAN KE 5,000.00
10.12.57 10.12.57 TRANSAC 1
760360420803001 | PT
TIONAL
BINA SAN PRIMA |
BANKING
pembayaran faktur obat
SERVICES
(TBS)
30/10/2018 30/10/2018 DIVISI 68449 TRANSFER KE |
PEMINDAHAN KE 3,214,868.00
10.12.57 10.12.57 TRANSAC 7
760360200001004 | PT.
TIONAL
ANUGRAH ARGON MEDIC
BANKING
SERVICES
(TBS)
 DIVISI
TRANSAC
TIONAL
BANKING
SERVICES
(TBS)
30/10/2018 30/10/2018 DIVISI 68449 TRANSFER KE |
PEMINDAHAN KE 5,000.00
10.12.57 10.12.57 TRANSAC 7
760360420803001 | PT.
TIONAL
ANUGRAH ARGON MEDIC
BANKING
SERVICES
(TBS) TRANSFER KE |
30/10/2018 30/10/2018 DIVISI 68461 PEMINDAHAN KE
TRANSAC 9,368,425.00
10.12.58 10.12.58 7 760360200001004 | pt
TI
penta

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 14

Journa
Posting Date Effective Date Branch Transaction Description Amount
l

ONAL valent | pembayaran faktur

BANKING obat
SERVICES
(TBS) TRANSFER KE |
30/10/2018 30/10/2018 DIVISI 68461 PEMINDAHAN KE
5,000.00
10.12.58 10.12.58 TRANSAC 7 760360420803001 | pt
TIONAL penta valent | pembayaran
BANKING faktur obat
SERVICES
(TBS) TRANSFER KE |
30/10/2018 30/10/2018 DIVISI 68463 PEMINDAHAN KE
6,388,305.00
10.12.58 10.12.58 TRANSAC 6 760360200001004 | PT
TIONAL KIMIA FARMA | pembayaran
BANKING faktur obat
SERVICES
(TBS)
 DIVISI
TRANSAC
TIONAL
BANKING
SERVICES
(TBS) TRANSFER KE |
30/10/2018 30/10/2018 DIVISI 68463 PEMINDAHAN KE
5,000.00
10.12.58 10.12.58 TRANSAC 6 760360420803001 | PT
TIONAL KIMIA FARMA | pembayaran
BANKING faktur obat
SERVICES
(TBS)
30/10/2018 30/10/2018 DIVISI 68465 TRANSFER KE | 16,672,425.0
10.12.58 10.12.58 1 PEMINDAHAN KE 0
TRANSAC
760360200001004 | PT
TIONAL
MENSA BINA SUKSES |
BANKING
pembayaran faktur obat
SERVICES
(TBS)
30/10/2018 30/10/2018 DIVISI 68465 TRANSFER KE |
PEMINDAHAN KE 5,000.00
10.12.58 10.12.58 TRANSAC 1
760360420803001 | PT
TIONAL
MENSA BINA SUKSES |
BANKING
pembayaran faktur obat
SERVICES
(TBS)
30/10/2018 30/10/2018 65509 TRF/PAY/TOP-UP ECHANNEL |
INTERNAL 9,504,805.00
10.59.06 10.59.06 6 4616990005432104 |
ON360008421137221137
30/10/2018 30/10/2018 DIVISI 10417 TRANSFER KE |
PEMINDAHAN KE 226,000.00
13.38.21 13.38.21 TRANSAC 0
760360200001004 | agus
TIONAL
gunawan | pembayaran
BANKING
plastik cream

ACCOUNT STATEMENT
KLINIK UTAMA SURYA Account No. : 489374593 - KLINIK UTAMA SURYA
MEDIKA
JL HASANUDDIN NO 33 Account Type : Saving
Period : 15-Oct-18 - 31-Oct-18
Page : 15
 Journa
Posting Date Effective Date Branch Transaction Description Amount
l

SERVICES
(TBS)
30/10/2018 30/10/2018 DIVISI 10417 TRANSFER KE |
PEMINDAHAN KE 5,000.00
13.38.21 13.38.21 TRANSAC 0
760360420803001 | agus
TIONAL
gunawan | pembayaran
BANKING
plastik cream
SERVICES
(TBS)
30/10/2018 30/10/2018 TRANSFER DARI |
INTERNET 90672 8,381,750.00
14.17.31 14.17.31 1 PEMINDAHAN DARI
BANKING
447903527 Ibu UCI
KHAIRIAH | Pengembalian
31/10/2018 31/10/2018 98737 Sisa Dana
INTERNAL JASA GIRO/BUNGA 118,337.00
00.00.00 00.00.00 BRANCH 9
31/10/2018 31/10/2018 INTERNAL 98737 PPH 23,668.00
00.00.00 00.00.00 BRANCH 9
31/10/2018 31/10/2018 INTERNAL 98737 BY ADMINISTRASI 10,000.00
00.00.00 00.00.00 BRANCH 9
31/10/2018 31/10/2018 INTERNAL 98737 BIAYA ADM KARTU 5,000.00
00.00.00 00.00.00 BRANCH 9
31/10/2018 31/10/2018 INTERNAL 98737 BIAYA ADM KARTU 7,500.00
00.00.00 00.00.00 BRANCH 9
Ending
Balance :
339,853,316.0
Total Debet : 78
0
339,818,593.0
Total Credit : 33
0
TAMA SURYA

Oct-18

DB/C
Amount Balance
R
69,282,683.00
1,154,396.00 K 70,437,079.00

659,571.00 D 69,777,508.00

5,000.00 D 69,772,508.00

117,600,000. 187,372,508.0
K
00 0
18,000,000.0 205,372,508.0
K
0 0

204,172,508.0
1,200,000.00 D
0
 202,276,508.0
1,896,000.00 D
0

201,698,370.0
578,138.00 D
0

TAMA SURYA

Oct-18

DB/C
Amount Balance
R

198,577,980.0
3,120,390.00 D
0

198,572,980.0
5,000.00 D
0
 197,854,553.0
718,427.00 D
0

197,849,553.0
5,000.00 D
0

192,212,953.0
5,636,600.00 D
0

192,207,953.0
5,000.00 D
0

190,107,953.0
2,100,000.00 D
0

TAMA SURYA

Oct-18
 DB/C
Amount Balance
R

187,885,653.0
2,222,300.00 D
0

187,880,653.0
5,000.00 D
0

188,126,653.0
246,000.00 K
0

13,190,000.0 201,316,653.0
K
0 0
13,190,000.0 188,126,653.0
D
0 0

188,388,044.0
261,391.00 K
0

188,887,294.0
499,250.00 K
0

18,000,000.0 170,887,294.0
D
0 0
TAMA SURYA

Oct-18

DB/C
Amount Balance
R

170,882,294.0
5,000.00 D
0

171,740,044.0
857,750.00 K
0

171,865,983.0
125,939.00 K
0

174,986,373.0
3,120,390.00 K
0

180,622,973.0
5,636,600.00 K
0
 172,901,306.0
7,721,667.00 D
0

172,896,306.0
5,000.00 D
0

TAMA SURYA

Oct-18

DB/C
Amount Balance
R

169,775,916.0
3,120,390.00 D
0

169,770,916.0
5,000.00 D
0
 164,134,316.0
5,636,600.00 D
0

164,129,316.0
5,000.00 D
0

163,070,430.0
1,058,886.00 D
0

161,119,630.0
1,950,800.00 D
0

169,710,423.0
8,590,793.00 K
0

TAMA SURYA

Oct-18
 DB/C
Amount Balance
R

50,000,000.0 219,710,423.0
K
0 0

30,972,500.0 188,737,923.0
D
0 0

188,732,923.0
5,000.00 D
0

188,778,983.0
46,060.00 K
0

186,944,843.0
1,834,140.00 D
0

180,013,723.0
6,931,120.00 D
0

25,298,790.0 154,714,933.0
D
0 0

154,709,933.0
5,000.00 D
0
TAMA SURYA

Oct-18

DB/C
Amount Balance
R

13,513,542.0 141,196,391.0
D
0 0

140,832,071.0
364,320.00 D
0

140,827,071.0
5,000.00 D
0

134,400,046.0
6,427,025.00 D
0

134,395,046.0
5,000.00 D
0
 133,421,046.0
974,000.00 D
0

142,499,431.0
9,078,385.00 K
0

TAMA SURYA

Oct-18

DB/C
Amount Balance
R

142,342,431.0
157,000.00 D
0

142,185,431.0
157,000.00 D
0
 142,028,431.0
157,000.00 D
0

141,871,431.0
157,000.00 D
0

141,714,431.0
157,000.00 D
0

140,714,431.0
1,000,000.00 D
0

TAMA SURYA

Oct-18
 DB/C
Amount Balance
R

139,714,431.0
1,000,000.00 D
0

138,714,431.0
1,000,000.00 D
0

137,714,431.0
1,000,000.00 D
0

138,131,226.0
416,795.00 K
0

139,140,879.0
1,009,653.00 K
0

138,703,379.0
437,500.00 D
0

138,265,879.0
437,500.00 D
0
TAMA SURYA

Oct-18

DB/C
Amount Balance
R

137,212,188.0
1,053,691.00 D
0

140,429,995.0
3,217,807.00 K
0

140,943,995.0
514,000.00 K
0
143,233,466.0
2,289,471.00 K
0

141,108,466.0
2,125,000.00 D
0

141,103,466.0
5,000.00 D
0
 10,000,000.0 131,103,466.0
D
0 0

133,961,059.0
2,857,593.00 K
0

TAMA SURYA

Oct-18

DB/C
Amount Balance
R

28,949,829.0 162,910,888.0
K
0 0

35,000,000.0 197,910,888.0
K
0 0
95,849,500.0 102,061,388.0
D
0 0
 101,125,308.0
936,080.00 D
0

101,120,308.0
5,000.00 D
0

105,143,013.0
4,022,705.00 K
0

105,311,404.0
168,391.00 K
0

108,226,275.0
2,914,871.00 K
0

108,059,275.0
167,000.00 D
0

TAMA SURYA

Oct-18
 DB/C
Amount Balance
R

107,087,275.0
972,000.00 D
0

107,799,006.0
711,731.00 K
0

10,000,000.0 117,799,006.0
K
0 0

117,626,007.0
172,999.00 D
0

112,989,654.0
4,636,353.00 D
0

113,994,654.0
1,005,000.00 K
0
114,323,555.0
328,901.00 K
0

114,190,805.0
132,750.00 D
0
TAMA SURYA

Oct-18

DB/C
Amount Balance
R

113,179,245.0
1,011,560.00 D
0

10,419,376.0 102,759,869.0
D
0 0

15,570,610.0
D 87,189,259.00
0

5,000.00 D 87,184,259.00

3,214,868.00 D 83,969,391.00
 5,000.00 D 83,964,391.00

9,368,425.00 D 74,595,966.00

TAMA SURYA

Oct-18

DB/C
Amount Balance
R

5,000.00 D 74,590,966.00

6,388,305.00 D 68,202,661.00
 5,000.00 D 68,197,661.00

16,672,425.0
D 51,525,236.00
0

5,000.00 D 51,520,236.00

9,504,805.00 K 61,025,041.00

226,000.00 D 60,799,041.00

TAMA SURYA

Oct-18
 DB/C
Amount Balance
R

5,000.00 D 60,794,041.00

8,381,750.00 K 69,175,791.00

118,337.00 K 69,294,128.00

23,668.00 D 69,270,460.00

10,000.00 D 69,260,460.00

5,000.00 D 69,255,460.00

7,500.00 D

69,247,960.00