NOTA PENCAIRAN DANA

Kepada : Penggunaan Anggaran

Dari : Pejabat Pelaksana Teknis Kegiatan ( PPTK ) Puskesmas Simundol
Nomor :
Tanggal :
Tembusan : 1 Yth Bendahara Pengeluaran
2 Yth Pejabat Pengelola Keuangan Dinas Kesehatan Kabupaten Padang Lawas Utara
Perihal : Permohonan Pencairan Anggaran Kegiatan ( Melalui SPP L-S)

1. Pedahuluan
Sesuai dengan SK Kepala Dinas Kesehatan Kabupaten Padang Lawas Utara Nomor : tanggal tentang penunjukan Pejabat Pelaksana Teknis Kegiatan (PPTK) Tahun 2021,
bahwa salah satu tugas PPTK adalah mengendalikan pelaksanaan Program Pemenuhan Upaya Kesehatan Perorangan dan Upaya Kesehatan Masyarakat dan salah satu sub kegiatannya adalah Operasional
Pelayanan Puskesmas dan jumlah dana kegiatan tersebut adalah Rp 83.250.000,- ( Delapun Puluh Tiga Juta Dua Ratus Lima Puluh Ribu Rupiah )

Program : Pemenuhan Upaya Kesehatan Perorangan dan Upaya Kesehatan Masyarakat

Sub Kegiatan : Operasional Pelayanan Puskesmas
Pelaksanaan Kegiatan : Juni, Juli dan Agustus 2021
Sumber Dana : DAK

a. Rencana Pengambilan Dana

Jumlah
No Kode rekening Uraian Kegiatan Nama Bank Nama Pemilik Rek No Rekening Bulan Juli Bulan Juni Bulan Agus Total NPWP
Non Tunai Tunai
1 Bank Sumut Sinar Ritonga, SKM 231.02.09.001.3351 2,400,000 1,650,000 4,050,000
2 Bank Sumut Hastuti Nasution, SKM 231.02.09.004.2231 2,850,000 0 2,850,000
3 Bank Sumut Yusmidar Sitepu, AmKeb 231.02.09.003.5515 2,700,000 0 2,700,000
4 Bank Sumut Roilan Harahap, AmKeb 231.02.09.003.5451 3,600,000 0 3,600,000
5 Bank Sumut Dahlan Ritonga, SKM 231.02.09.002.6058 3,000,000 0 3,000,000
6 Bank Sumut Riyani, AmKeb 231.02.09.003.1352 2,250,000 0 2,250,000
7 Bank Sumut Ngatia 231.02.09.003.5527 1,800,000 0 1,800,000
8 Bank Sumut Desi Marito Ritonga, SKM 231.02.03.001.7695 2,250,000 0 2,250,000 86,098,829,416,000
9 Bank Sumut Julica Iskandar, AmKeb 231.02.09.004.0831 3,150,000 2,700,000 5,850,000
10 Belanja Trnasport Bank Sumut Mimi Suryana Kesuma, AmKeb 231.02.09.003.1251 1,350,000 2,250,000 3,600,000
1.02.02.2.02.33.5.1
11 Kegiatan Dalam Bank Sumut Fitri Anggriani,SST 231.02.09.003.3245 3,000,000 2,100,000 5,100,000
.02.04.01.0004 Kabupaten / Kota
12 Bank Sumut Delly T.F. Suryanto, S.Kep,Ns 231.02.09.004.8634 1,050,000 2,250,000 3,300,000
13 Bank Sumut Nurdiana Putri Ritonga, SKM 231.02.03.002.0742 1,200,000 0 1,200,000 419,162,862,118,000
14 Bank Sumut Widawati, AmKeb 231.02.09.002.6061 3,000,000 1,800,000 4,800,000
15 Bank Sumut Lili Herawati Ritonga, AmKep 231.02.09.003.2824 2,850,000 0 2,850,000
16 Bank Sumut Eva Surianta, SKM 231.02.09.003.4973 2,100,000 1,500,000 3,600,000
17 Bank Sumut Resli Elmeria Damanik 231.02.09.003544-8 2,550,000 1,500,000 4,050,000
18 Bank Sumut Yuyun Kurnia Harahap, AmKeb 231.02.09.004.0746 3,000,000 2,400,000 5,400,000
19 Bank Sumut Mastulen Hasibuan, Amkep 231.02.09.003.1341 2,850,000 0 2,850,000
20 Bank Sumut Nilawati Siregar, AmKeb 231.02.09002.6070 2,850,000 0 2,850,000
21 Bank Sumut Meri Hasibuan, AmKep 231.02.09.003.5460 150,000 0 150,000
 Jumlah
No Kode rekening Uraian Kegiatan Nama Bank Nama Pemilik Rek No Rekening Bulan Juli Bulan Juni Bulan Agus Total NPWP
Non Tunai Tunai
22 Bank Sumut dr. Muhammad Rizki Saragi 231.02.09.004.0656 450,000 1,500,000 1,950,000
23 Bank Sumut Diana Wahyuni 231.02.09.003.3002 750,000 0 750,000
24 Bank Sumut Deliana Nasution, AmKeb 231.02.09.004.1914 150,000 0 150,000
25 Bank Sumut Mardiana, AmKeb 231.02.09.004.0794 3,150,000 0 3,150,000
26 Bank Sumut Siti Afri Zenny Haharap, AmKeb 231.02.09.004.1402 600,000 0 600,000
27 Bank Sumut Nurhamidah Ritonga, AmKeb 231.02.09.004.1321 600,000 0 600,000
28 Bank Sumut Riana,AmKeb 231.02.09.0042360 1,950,000 300,000 2,250,000
29 Bank Sumut Desni Puspita,AmKeb 231.02.09.004.1892 150,000 0 150,000
30 Bank Sumut Nurbulan Ritonga, AmKeb 231.02.09.004.2231 1,050,000 0 1,050,000
31 Bank Sumut Megawati Siregar, AmKeb 231.02.09.004.2382 450,000 0 450,000
32 Bank Sumut Iin Purwati Ritonga, AmKeb 231.02.09.004.1391 1,350,000 0 1,350,000
33 Bank Sumut Devi Hasibuan, AmKeb 231.02.09.004.2183 150,000 0 150,000
34 Bank Sumut Mahyuni Ritonga, AmKeb 231.02.09.004.0783 1,350,000 0 1,350,000
35 Bank Sumut Fitriah Nasution, AmKeb 231.02.09.004.2205 300,000 0 300,000
36 Bank Sumut Juliati Rambe, AmKeb 231.02.09.004.0750 450,000 0 450,000
37 Belanja Trnasport Bank Sumut Elvina hasibuan, AmKeb 231.02.09.004.1962 150,000 0 150,000
1.02.02.2.02.33.5.1 Kegiatan Dalam
38 .02.04.01.0004 Kabupaten / Kota Bank Sumut Saudatul hanim Ritonga, AmKeb 231.02.09.004.1376 1,950,000 0 1,950,000
39 Bank Sumut Siti Aisyah Rambe, AmKeb 231.02.09.004.1424 750,000 0 750,000
40 Bank Sumut Yatmi, AmKeb 231.02.09.0040853 2,100,000 1,200,000 3,300,000
41 Bank Sumut Nirmalasari, AmKeb 231.02.09.004.0735 150,000 0 150,000
42 Bank Sumut Irma Suryani Pasaribu, AmKeb 231.02.09.004.2851 150,000 1,500,000 1,650,000
43 Bank Sumut Mahdalena Pohan 231.02.09.003.2836 300,000 0 300,000
44 Bank Sumut Juli Astati 231.02.09.004.1380 300,000 0 300,000
45 Bank Sumut Nurhayati 231.02.09.004.9172 450,000 0 450,000
46 Bank Sumut Khoirun Tamimi 2,310,090,049,964 600,000 0 600,000
47 Bank Sumut Ainil Fitri 231.02.09.004.2194 150,000 0 150,000
48 Bank Sumut Risnawaty Ginting, AmKeb 231.02.09.003.3063 2,100,000 1,500,000 3,600,000
49 Bank Sumut Reni Fadila Ritonga, AmKeb 231.02.09.003.2848 750,000 0 750,000
50 Bank Sumut dr.Karno 231.02.09.004.2076 7,500,000 0 7,500,000
51 Bank Sumut Lisna Ritonga,Am.Keb 231.02.09.003.5485 0 600,000 600,000
52 Bank Sumut Mahir Ritonga,Am.Kep 231.02.09.003.3166 0 1,500,000 1,500,000
53 Bank Sumut Irma Dalimunthe,Am.Keb 231.02.09.003.2851 0 2,100,000 2,100,000
54 5.1.02.01.01.0024 ATK Bank Sumut 0 5,127,700 5,127,700 89.456.856.7-118.000
Sahbansyah Rambe 231.02.09.00.2960
55 5.1.02.01.01.0026 Spanduk Bank Sumut 0 556,800 556,800
56 5.1.02.01.01.0052 Makan Bank Sumut Kiki Pradana Rambe 231.02.03.001.7135 0 9,000,000 9,000,000 76.146.702.6-118.000

57 5.1.02.04.01.0004 Transport Sosialisasi Bank Sumut Sinar Ritonga,SKM 231.02.09.001.3351 36,000,000

0 36,000,000
58 Nara Sumber Bank Sumut Nur Siah Harahap 231.02.09.003.8753 0 2,700,000 2,700,000
5.1.02.02.01.0003
59 Nara Sumber Bank Sumut Hj. Masnaini Nasution, SKM 231.02.09.0008226 0 2,700,000 2,700,000

Transport Sosialisasi
60 5.1.02.04.01.0004 Refresing Kader Bank Sumut Sinar Ritonga,SKM 231.02.09.001.3351 15,000,000 0 15,000,000
JUMLAH 95,250,000 84,434,500 179,684,500