LAMPIRAN 1

DAFTAR PPN Dan PPn BM YANG DIPUNGUT OLEH BENDAHARAWAN PEMERINTAH FORMULIR

Masa 0 7 s.d. 0 7 - 2 0 1 9
1107
DEPARTEMEN KEUANGAN: RI
DIREKTORAT JENDERAL PAJAK
Pembetulan Ke- 0 ( Nol )
PUT 1
NAMA PEMUNGUT : OMBUDMAN REPUBLIK INDONESIA

NPWP : 00.444.593.8-025.000

Faktur Pajak Nomor dan Tanggal Setor

Tanggal Bayar
No. Nama Rekanan NPWP Rekanan Kode Seri FP DPP (Rupiah) PPN (Rupiah) PPn BM (Rupiah)
Kode dan Nomor Seri Tanggal Tagihan PPN PPn
Yang Diganti

A. PPN dan PPn BM YANG DIPUNGUT OLEH PENERBIT SPM MELALUI KPPN
1. CV. FAREL ARKHAN NANJAYA 71.620.518.2-001.000 020.003-19.14219757 01/07/2019 11.363.636 1.136.363 0 02/07/2019 07/08/2019

2. CV KHANZA MAHA TIRANA 80.296.988.1-085.000 020.003-19.14221021 01/07/2019 8.195.000 819.500 0 10/07/2019 07/08/2019

3. CV SEMPURNA JAYA INDONESIA 84.133.822.1-001.000 020.003-19.15378465 02/07/2019 6.727.273 672.727 0 24/07/2019 07/08/2019

4. CV SEMPURNA JAYA INDONESIA 84.133.822.1-001.000 020.003-19.15378512 01/07/2019 3.363.636 336.363 0 23/07/2019 07/08/2019

5. CV. PARAWA CITRA 01.807.046.6-005.000 020.003-19.17857330 01/07/2019 35.500.000 3.550.000 0 15/07/2019 07/08/2019

6. CV. KHARISMA ABADI 02.269.471.5-434.000 020.003-19.18302944 01/07/2019 21.818.182 2.181.818 0 02/07/2019 07/08/2019

7. PT.PERUSAHAAN PERDAGANGAN 01.001.661.6-051.000 020.004-19.22780772 01/07/2019 181.818.181 18.181.818 0 05/07/2019 07/08/2019

INDONESIA

8. CV JULANG ARTHA LESTARI 03.189.848.9-009.000 020.003-19.23325598 24/07/2019 6.818.182 681.818 0 31/07/2019 07/08/2019

9. PT ADHYAKSA PERSADA 70.578.052.6-445.000 020.003-19.27348558 01/07/2019 42.427.000 4.242.700 0 02/07/2019 07/08/2019

INDONESIA

10. PT ADHYAKSA PERSADA 70.578.052.6-445.000 020.003-19.27348559 01/07/2019 21.140.000 2.114.000 0 10/07/2019 07/08/2019
INDONESIA

11. CV. AZIO OSAKA 90.703.556.2-071.000 020.004-19.27893709 01/07/2019 17.400.000 1.740.000 0 10/07/2019 07/08/2019

12. CV. AZIO OSAKA 90.703.556.2-071.000 020.004-19.27893710 01/07/2019 4.500.000 450.000 0 02/07/2019 07/08/2019

13. CV. AZIO OSAKA 90.703.556.2-071.000 020.004-19.27893726 09/07/2019 6.135.000 613.500 0 23/07/2019 07/08/2019

D.1.2.32.03
r

n BM
 14. CV. AZIO OSAKA 90.703.556.2-071.000 020.004-19.27893727 08/07/2019 3.250.000 325.000 0 22/07/2019 07/08/2019

15. CV MULYA UTAMA 03.331.157.2-416.000 020.003-19.29110651 01/07/2019 3.300.000 330.000 0 12/07/2019 07/08/2019

16. CV MULYA UTAMA 03.331.157.2-416.000 020.003-19.29110652 01/07/2019 8.500.000 850.000 0 12/07/2019 07/08/2019

17. CV MAR RAHMAN 85.920.372.1-017.000 020.003-19.32126710 23/07/2019 5.214.000 521.400 0 31/07/2019 07/08/2019

18. CV MAR RAHMAN 85.920.372.1-017.000 020.003-19.32126711 29/07/2019 12.430.500 1.243.050 0 31/07/2019 07/08/2019

19. CV SANDIATAMA PASIFIC 84.137.895.3-002.000 020.003-19.33619194 02/07/2019 7.454.545 745.454 0 23/07/2019 07/08/2019

20. CV. MANDALA TIRTA NIAGA 85.410.197.9-085.000 020.004-19.43170838 01/07/2019 45.065.000 4.506.500 0 10/07/2019 07/08/2019

21. PT. TIRTA INVESTAMA 01.674.376.7-092.000 020.004-19.46097829 01/07/2019 11.775.636 1.177.563 0 12/07/2019 07/08/2019

22. PT. JASNITA TELEKOMINDO 01.770.132.7-076.000 020.005-19.52676571 03/07/2019 265.591.680 26.559.168 0 23/07/2019 07/08/2019

23. PT GEMILANG INDONESIA 82.671.515.3-448.000 020.004-19.64264534 01/07/2019 90.909.091 9.090.909 0 10/07/2019 07/08/2019
SUKSES MULIA

24. PT.BHINNEKA MENTARIDIMENSI 01.608.941.9-027.000 020.002-19.72168716 01/07/2019 60.363.636 6.036.363 0 22/07/2019 07/08/2019

25. MAXINDO NETWORK PT 03.040.785.2-047.000 020.004-19.76330172 01/07/2019 15.454.546 1.545.454 0 02/07/2019 07/08/2019

26. MAXINDO NETWORK PT 03.040.785.2-047.000 020.004-19.76331831 23/07/2019 18.181.818 1.818.181 0 31/07/2019 07/08/2019

27. PT. MANDAKIRO WASTIRU 03.064.974.3-015.000 020.002-19.78094391 01/07/2019 109.090.909 10.909.090 0 15/07/2019 07/08/2019
PRATAMA

28. PT. HIPERNET INDODATA 02.485.008.3-036.000 020.003-19.92385913 01/07/2019 18.181.818 1.818.181 0 23/07/2019 07/08/2019
(HYPERNET)

29. PD PAL JAYA 01.061.068.1-062.000 020.003-19.96994724 01/07/2019 5.406.034 540.603 0 18/07/2019 07/08/2019

30. PT. MITRA COPIERINDO MANDIRI 02.346.335.9-029.000 020.002-19.99030629 01/07/2019 30.606.400 3.060.640 0 18/07/2019 07/08/2019

31. PT. MITRA COPIERINDO MANDIRI 02.346.335.9-029.000 020.002-19.99030630 01/07/2019 2.695.000 269.500 0 18/07/2019 07/08/2019

JUMLAH - dipindahkan ke Formulir 1107 PUT 1.080.676.703 108.067.663 0

B. PPN dan PPn BM YANG DIPUNGUT OLEH BENDAHARA PENGELUARAN

1. CV. AZIO OSAKA 90.703.556.2-071.000 020.004-19.27893728 15/07/2019 7.100.000 710.000 0 15/07/2019 07/08/2019

2. CV MAR RAHMAN 85.920.372.1-017.000 020.003-19.32126709 01/07/2019 3.840.000 384.000 0 08/07/2019 07/08/2019

D.1.2.32.03
 3. CV SANDIATAMA PASIFIC 84.137.895.3-002.000 020.003-19.33840650 04/07/2019 7.090.909 709.090 0 05/07/2019 07/08/2019

4. CV ZEROZI BERLIAN 03.257.321.4-005.000 020.005-19.63382152 10/07/2019 8.545.455 854.545 0 17/07/2019 07/08/2019

JUMLAH - dipindahkan ke Formulir 1107 PUT 26.576.364 2.657.635 0

C. JUMLAH ( A + B ) 1.107.253.067 110.725.298 0

D.1.2.32.03