Nomor : B / / 102023 KEDIRI, 27-10-2023

Lampira : 1

Kepada Yth.
Bapak/Ibu
PRAKTEK KLINIK PRODI D3 KEPERAWATAN STIKES PAMENANG DI RSKK
DI
JL. SOEKARNO HATTA N

Perihal : Penetapan Iuran Pertama Kepesertaan Bukan Penerima Upah

Berdasarkan pendaftaran yang dilakukan oleh Wadah untuk menjadi peserta Bukan Penerima Upah (BPU) di
BPJS Ketenagakerjaan, bersama ini kami tetapkan besaran iuran yang harus dibayaran dengan penjelasan
sebagai berikut :

Program Jumlah TK Dasar Upah Jumlah Iuran

(Rp) (Rp)
JHT 0 0.00 0.00
JKM 49 49,000,000.00 999,600.00
JKK 49 49,000,000.00 1,470,000.00
Jumlah iuran yang harus dibayar 2,469,600.00

Pembayaran di atas dapat dilakukan melalui kanal pembayaran antara lain ATM dan Teller Bank kerjasama
(Mandiri, BRI, BTN, BCA, BJB, BNI), Indomaret, Alfamart, Tokopedia, PPOB atau metode pembayaran
lainya dengan menggunakan kode tagihan dibawah ini :

Nomor Kode Tagihan : 0626231000208247

Perlindungan sosial ketenagakerjaan diberikan kepada peserta sejak iuran pertama tersebut dibayarkan.

Demikian kami sampaikan, atas perhatianya kami ucapkan terima kasih.

TRI BOEANA WIDAYANTI KR

KEPALA BIDANG PEMASARAN BPU
 RINCIAN IURAN TENAGA KERJA BUKAN PENERIMA UPAH
BPJS KETENAGAKERJAAN

NO NIK NAMA BLTH BLN Penghasilan Dasar Upah JHT JKK JKM Iuran JHT Iuran JKK Iuran JKM Total Iuran Kode Iuran

1 3506264603030001 SOFWATUL UMMAH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

2 3506195403030001 AGHISNA MAYLA MAKSUM 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321
IRSYADA SABILA
3 3506164507030001 JAUHAROTUL INTAN 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321
JAZZILAH
4 3506146106020002 JUNIE FRANSISKA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

5 3506100903030003 MUHAMMAD FAKHRI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

6 3506084811020001 ANISA SILVIANA PUTRI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

7 3516074506020004 NUR FADILA FAUZIAH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

8 3506176109020005 NADIA AULIA FARRAS 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

9 6405026808010004 NUR SYAFIQAH AYU 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

10 3506085202020002 PINGKI BERLINDA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

FEBRIANTI
11 3506112110010001 JOKO PRANOWO 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

12 3506095104030002 ANANTA KRISTINA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

DAMAYANTI
13 3506165707020001 ELVINA WANDA YULIA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

14 6474015702010003 IVA NURAINI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

15 3506172009010002 MOHAMAD NAUFAL 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

HANAFI
16 3506264704030002 ERIKA NUR AINI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

17 3506161904020001 MOHAMAD YOGA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

ARDIANSYAH
18 3506186609020001 ANDINI POPPY WIDYARINI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

19 3517036103030001 ERIN NAILA WAFIROH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

KNR50501
 RINCIAN IURAN TENAGA KERJA BUKAN PENERIMA UPAH
BPJS KETENAGAKERJAAN

NO NIK NAMA BLTH BLN Penghasilan Dasar Upah JHT JKK JKM Iuran JHT Iuran JKK Iuran JKM Total Iuran Kode Iuran

20 3506174301020001 JESSICHA NATAZYA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

BUDIONO
21 3506171810020001 OCHVAN PANDU 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321
WICAKSONO
22 3506145606020001 ETRIYA KUSUMA WARDANI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

23 3506175201030001 AULIA PUTRI RAHMAWATI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

24 3517046711010003 EVA AYU SORAYA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

25 3516062208990004 WIRA ADHIKUSUMA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

26 3506104505030005 FIMLA SAIDA AZMI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

27 3506166001030006 LILIEN JUAN TRISIA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

28 3506174404030003 FITRI APRILIA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

29 3506095206020001 ZUSMANIAR RIZKIA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

AFIFAHNUR
30 3506085007020002 DEREN PUJA AYUNDA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

31 3525152110020002 SUNARKO DANU 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

ARDIANTO
32 3518076206030003 MARLIZA AFICENA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321
CAHYANI LUSIA
33 3515091204030003 M. TAUFIQURROKHIM 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

34 3506074706020002 NABILA FATIMA AZZAHRA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

35 3506165111020001 NOVITA NUR FADILAH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

36 3506210306030002 YOGI SATRIO LELONO 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

37 3506186605030001 NABILA PUTRI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

REGINASARI
38 3517191208980001 ZIAN UL HAQ 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

KNR50501
 RINCIAN IURAN TENAGA KERJA BUKAN PENERIMA UPAH
BPJS KETENAGAKERJAAN

NO NIK NAMA BLTH BLN Penghasilan Dasar Upah JHT JKK JKM Iuran JHT Iuran JKK Iuran JKM Total Iuran Kode Iuran

39 3506216803020001 CATUR ENDHAH WAHYUNI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

40 3506171807020003 MUHAMMAD ADAM 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

ALFARIZI
41 3506176005020002 NOR MUDHALIFAH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

42 3506175403030001 REGITA AUDYANA ALVIANI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

43 3506174201030003 RIZA ARVIANTI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

MUFARIKHA
44 3506116407030001 REZA AULIA NISA' 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

45 3506266610010001 RESA ANAWIDHIYANTI 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

46 3506264407010002 YULIA FARADITA EKA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321
PUTRI
47 3316057112030001 REDITA NUR ARIFA 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

48 3506156107030002 PRASTIANING DIAH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

PALUPI
49 3518166607020002 NURUL KHASANAH 10-2023 3 1,000,000 0 1 1 0 30,000 20,400 50,400 923100034321

TOTAL 49,000,000 0 49 49 0 1,470,000 999,600 2,469,600

KNR50501