New Microsoft Excel Worksheet

PEMBAGIAN JASA PERSALINAN PBI,NO
klaim persal Rp 8,415,000

+pra ruj
Jaspel Bidan Rp 5,469,750 persal Normal
pajak 0
terima Rp 5,469,750 vol vee total vee
1. Haryati 0 Rp 200,000 Rp -
2. Rusiyani 0 Rp 200,000 Rp -
3. Rokhani 1 Rp 200,000 Rp 200,000
4. Siti Salamah 2 Rp 200,000 Rp 400,000
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 3 Rp 200,000 Rp 600,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 2 Rp 200,000 Rp 400,000
9.Datang Sendiri 2 Rp 200,000 Rp 400,000
10.Rosdiana 1 Rp 200,000 Rp 200,000
11.Tri 1 Rp 200,000 Rp 200,000
12.Ida 1 Rp 200,000 Rp 200,000
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 13 Rp 50,000 Rp 650,000
1. Haryati 2 Rp 200,000 Rp 400,000
3. Rokhani 2 Rp 200,000 Rp 400,000
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 1 Rp 200,000 Rp 200,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 0 Rp 200,000 Rp -
10.Rosdiana 1 Rp 200,000 Rp 200,000
11.Tri 0 Rp 200,000 Rp -
12.Ida 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 11 Rp 50,000 Rp 550,000
1. Haryati 2 Rp 200,000 Rp 400,000
2. Rusiyani 2 Rp 200,000 Rp 400,000
3. Rokhani 0 Rp 200,000 Rp -
5. Retno 1 Rp 200,000 Rp 200,000
6. Dyah E 0 Rp 200,000 Rp -
7. Nurul H 0 Rp 200,000 Rp -
10.Rosdiana 1 Rp 200,000 Rp 200,000
11. Dyah R 1 Rp 200,000 Rp 200,000
12.Rumini 0 Rp 200,000 Rp -
13.Kamini 1 Rp 100,000 Rp 100,000
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 13 Rp 50,000 Rp 650,000
1. Haryati 4 Rp 200,000 Rp 800,000
2. Rusiyani 1 Rp 200,000 Rp 200,000
3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 1 Rp 200,000 Rp 200,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 7 Rp 200,000 Rp 1,400,000
9.Datang Sendiri 0 Rp 200,000 Rp -
10.Rosdiana 0 Rp 200,000 Rp -
11. Dyah R 0 Rp 200,000 Rp -
12.Kamini 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 16 Rp 50,000 Rp 800,000
1. Haryati 3 Rp 200,000 Rp 600,000
3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 1 Rp 200,000 Rp 200,000
6. Dyah E 1 Rp 200,000 Rp 200,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 6 Rp 200,000 Rp 1,200,000
10.Rosdiana 3 Rp 200,000 Rp 600,000
11. Dyah R 2 Rp 200,000 Rp 400,000
12.Rumini 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 24 Rp 50,000 Rp 1,200,000
1. Haryati 3 Rp 200,000 Rp 600,000
3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 1 Rp 200,000 Rp 200,000
6. Dyah E 0 Rp 200,000 Rp -
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 2 Rp 200,000 Rp 400,000
10.Rosdiana 2 Rp 200,000 Rp 400,000
11. Endang 1 Rp 200,000 Rp 200,000
12.Rumini 1 Rp 200,000 Rp 200,000
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 12 Rp 50,000 Rp 600,000
1. Haryati 1 Rp 200,000 Rp 200,000
2. Rusiyani 1 Rp 200,000 Rp 200,000
3. Rokhani 0 Rp 200,000 Rp -
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 0 Rp 200,000 Rp -
7. Nurul H 1 Rp 200,000 Rp 200,000
10.Rosdiana 1 Rp 200,000 Rp 200,000
11.Dyah Rina 2 Rp 200,000 Rp 400,000
12.Rumini 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 9 Rp 50,000 Rp 450,000
SA PERSALINAN PBI,NON PBI& PRA RUJUKAN PBI,FEBRUARI 2022
pra Rujukan TOTAL 2%
Ve Penolong PNC
vol vee total vee
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555

0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555
1 Rp 50,000 Rp 50,000 Rp 277,750 Rp - Rp 527,750 Rp 10,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 677,750 Rp 13,555
1 Rp 50,000 Rp 50,000 Rp 277,750 Rp - Rp 327,750 Rp 6,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 877,750 Rp 17,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 677,750 Rp 13,555
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 477,750 Rp 9,555
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
2 Rp 10,000 Rp 20,000 Rp 670,000 Rp 13,400
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 871,889 Rp 17,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 471,889 Rp 9,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 471,889 Rp 9,438
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 10,000 Rp - Rp 550,000 Rp 11,000
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 885,944 Rp 17,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 485,944 Rp 9,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 485,944 Rp 9,719
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp 100,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 10,000 Rp - Rp 650,000 Rp 13,000
1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 1,155,639 Rp 23,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 505,639 Rp 10,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 505,639 Rp 10,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 705,639 Rp 14,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 305,639 Rp 6,113
2 Rp 50,000 Rp 100,000 Rp 305,639 Rp - Rp 605,639 Rp 12,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 305,639 Rp 6,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 1,705,639 Rp 34,113
0 Rp 50,000 Rp - Rp -
1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 355,639 Rp 7,113
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
4 Rp 10,000 Rp 40,000 Rp 840,000 Rp 16,800
1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 1,144,917 Rp 22,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 494,917 Rp 9,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 694,917 Rp 13,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,294,917 Rp 25,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 694,917 Rp 13,898
1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 744,917 Rp 14,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 494,917 Rp 9,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,694,917 Rp 33,898
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,094,917 Rp 21,898
0 Rp 50,000 Rp - Rp - Rp - Rp 400,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
2 Rp 10,000 Rp 20,000 Rp 1,220,000 Rp 24,400
2 Rp 50,000 Rp 100,000 Rp 215,583 Rp - Rp 915,583 Rp 18,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 615,583 Rp 12,312
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 615,583 Rp 12,312
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
2 Rp 10,000 Rp 20,000 Rp 620,000 Rp 12,400
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 583,181 Rp 11,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
1 Rp 50,000 Rp 50,000 Rp 183,181 Rp - Rp 433,181 Rp 8,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664
0 Rp 50,000 Rp - Rp - Rp - Rp 400,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
1 Rp 10,000 Rp 10,000 Rp 460,000 Rp 9,200
Rp 41,374,125 Rp 789,483
5130204.72
TERIMA TANDA TANGAN
Rp 272,195 1
Rp 272,195 2
Rp 517,195 3
Rp 664,195 4
Rp 321,195 5
Rp 860,195 6
Rp 272,195 7
Rp 664,195 8
9
Rp 468,195 10
Rp 200,000 11
Rp 200,000 12
Rp - 13
Rp - 14
Rp 656,600 15
Rp 658,451 1
Rp 266,451 2
Rp 658,451 3
Rp 854,451 4
Rp 266,451 5
Rp 462,451 6
Rp 266,451 7
Rp 266,451 8
9
Rp 462,451 10
Rp - 11
Rp - 12
Rp - 13
Rp - 14
Rp 539,000 15
Rp 672,226 1
Rp 672,226 2
Rp 280,226 3
Rp 868,226 4
Rp 476,226 5
Rp 280,226 6
Rp 280,226 7
Rp 280,226 8
9
Rp 476,226 10
Rp 200,000 11
Rp - 12
Rp 100,000 13
Rp - 14
Rp 637,000 15
Rp 1,132,526 1
Rp 495,526 2
Rp 495,526 3
Rp 691,526 4
Rp 299,526 5
Rp 593,526 6
Rp 299,526 7
Rp 1,671,526 8
9
Rp 348,526 10
Rp - 11
Rp - 12
Rp - 13
Rp - 14
Rp 823,200 15
Rp 1,122,018 1
Rp 485,018 2
Rp 681,018 3
Rp 1,269,018 4
Rp 681,018 5
Rp 730,018 6
Rp 485,018 7
Rp 1,661,018 8
9
Rp 1,073,018 10
Rp 400,000 11
Rp - 12
Rp - 13
Rp - 14
Rp 1,195,600 15
Rp 897,272 1
Rp 211,272 2
Rp 407,272 3
Rp 407,272 4
Rp 407,272 5
Rp 211,272 6
Rp 211,272 7
Rp 603,272 8
9
Rp 603,272 10
Rp 200,000 11
Rp 200,000 12
Rp - 13
Rp - 14
Rp 607,600 15
Rp 375,517 1
Rp 375,517 2
Rp 179,517 3
Rp 571,517 4
Rp 179,517 5
Rp 179,517 6
Rp 424,517 7
Rp 179,517 8
9
Rp 375,517 10
Rp 400,000 11
Rp - 12
Rp - 13
Rp - 14
Rp 450,800 15
Rp 40,584,643
40,584,642.50
40,584,642.50
162338570
PEMBAGIAN JASA PERSALINAN PBI,N
klaim persal +pra Rp 8,415,000
ruj
pajak 0
1. Haryati 0 Rp 200,000 Rp -
3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 3 Rp 200,000 Rp 600,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 2 Rp 200,000 Rp 400,000
10.Rosdiana 1 Rp 200,000 Rp 200,000
11.Tri 1 Rp 200,000 Rp 200,000
12.Ida 1 Rp 200,000 Rp 200,000
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 13 Rp 50,000 Rp 650,000
Rp 3,250,000
Sisa Rp 2,099,750
Sisa+dtg sendiri Rp 2,499,750
Operasional Pkm Rp 1,683,000

pajak Rp 103,568
Rp 1,579,432 2% Rp 31,589
dr.visite 15 Rp 5,000 Rp 75,000
bendahara Rp 1,472,843
Tanda Tangan
TOTAL KLAIM Rp 8,415,000
TOTAL PAJAK Rp 208,757
1% (BLUD) Rp 84,150 Umi Kulsum
Rp 8,415,000
ruj
pajak 0
1. Haryati 2 Rp 200,000 Rp 400,000

3. Rokhani 2 Rp 200,000 Rp 400,000
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 1 Rp 200,000 Rp 200,000
7. Nurul H 0 Rp 200,000 Rp -
10.Rosdiana 1 Rp 200,000 Rp 200,000
11.Tri 0 Rp 200,000 Rp -
12.Ida 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 11 Rp 50,000 Rp 550,000
Rp 2,750,000
Sisa Rp 2,047,000

pajak Rp 90,832 T
Rp 1,385,168 2% Rp 27,703
dr.visite 11 Rp 5,000 Rp 55,000
Tanda Tangan
Rp 7,380,000

ruj
pajak 0
1. Haryati 2 Rp 200,000 Rp 400,000

2. Rusiyani 2 Rp 200,000 Rp 400,000
3. Rokhani 0 Rp 200,000 Rp -
5. Retno 1 Rp 200,000 Rp 200,000
6. Dyah E 0 Rp 200,000 Rp -
7. Nurul H 0 Rp 200,000 Rp -
10.Rosdiana 1 Rp 200,000 Rp 200,000
11. Dyah R 1 Rp 200,000 Rp 200,000
12.Rumini 0 Rp 200,000 Rp -
13.Kamini 1 Rp 100,000 Rp 100,000
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 13 Rp 50,000 Rp 650,000
Rp 3,150,000
Sisa Rp 2,173,500

pajak Rp 113,400
Rp 1,524,600 2% Rp 30,492
dr.visite 13 Rp 5,000 Rp 65,000
Tanda Tangan
Rp 8,190,000

ruj
pajak 0
1. Haryati 4 Rp 200,000 Rp 800,000

2. Rusiyani 1 Rp 200,000 Rp 200,000
3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 1 Rp 200,000 Rp 200,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 7 Rp 200,000 Rp 1,400,000
10.Rosdiana 0 Rp 200,000 Rp -
11. Dyah R 0 Rp 200,000 Rp -
12.Kamini 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 16 Rp 50,000 Rp 800,000
Rp 4,000,000
Sisa Rp 2,750,750

pajak Rp 148,914
Rp 2,002,086 2% Rp 40,042
dr.visite 20 Rp 5,000 Rp 100,000
Tanda Tangan
Rp 10,755,000

ruj
pajak 0
1. Haryati 3 Rp 200,000 Rp 600,000

3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 1 Rp 200,000 Rp 200,000
6. Dyah E 1 Rp 200,000 Rp 200,000
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 6 Rp 200,000 Rp 1,200,000
10.Rosdiana 3 Rp 200,000 Rp 600,000
11. Dyah R 2 Rp 200,000 Rp 400,000
12.Rumini 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 24 Rp 50,000 Rp 1,200,000
Rp 6,000,000
Sisa Rp 3,854,250

pajak Rp 212,472 T
Rp 2,856,528 2% Rp 57,131
dr.visite 26 Rp 5,000 Rp 130,000
Tanda Tangan
ruj
pajak 0
1. Haryati 3 Rp 200,000 Rp 600,000

3. Rokhani 1 Rp 200,000 Rp 200,000
5. Retno 1 Rp 200,000 Rp 200,000
6. Dyah E 0 Rp 200,000 Rp -
7. Nurul H 0 Rp 200,000 Rp -
8.Nurwaeti 2 Rp 200,000 Rp 400,000
10.Rosdiana 2 Rp 200,000 Rp 400,000
11. Endang 1 Rp 200,000 Rp 200,000
12.Rumini 1 Rp 200,000 Rp 200,000
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 12 Rp 50,000 Rp 600,000
Rp 3,000,000
Sisa Rp 1,940,250

pajak Rp 107,787
Rp 1,449,213 2% Rp 28,984
dr.visite 14 Rp 5,000 Rp 70,000
Tanda Tangan
Rp 7,785,000

ruj
pajak 0
1. Haryati 1 Rp 200,000 Rp 200,000

2. Rusiyani 1 Rp 200,000 Rp 200,000
3. Rokhani 0 Rp 200,000 Rp -
5. Retno 0 Rp 200,000 Rp -
6. Dyah E 0 Rp 200,000 Rp -
7. Nurul H 1 Rp 200,000 Rp 200,000
10.Rosdiana 1 Rp 200,000 Rp 200,000
11.Dyah Rina 2 Rp 200,000 Rp 400,000
12.Rumini 0 Rp 200,000 Rp -
13.( B Luar) 0 Rp 100,000 Rp -
14.(B Lu) 0 Rp 100,000 Rp -
15.Kary.BLUD 9 Rp 50,000 Rp 450,000
Rp 2,250,000
Sisa Rp 1,448,625

pajak Rp 80,064
Rp 1,076,436 2% Rp 21,529
dr.visite 10 Rp 5,000 Rp 50,000
Tanda Tangan
Umi Kulsum
Rp 5,782,500
ASA PERSALINAN PBI,NON PBI& PRA RUJUKAN PBI,FEBRUARI 2022
Ve Penolong PNC
vol vee total vee
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555

0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555
1 Rp 50,000 Rp 50,000 Rp 277,750 Rp - Rp 527,750 Rp 10,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 677,750 Rp 13,555
1 Rp 50,000 Rp 50,000 Rp 277,750 Rp - Rp 327,750 Rp 6,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 877,750 Rp 17,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 677,750 Rp 13,555
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 477,750 Rp 9,555
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
2 Rp 10,000 Rp 20,000 Rp 670,000 Rp 13,400
Rp 120,000 Rp 2,499,750 Rp - Rp 5,469,750 Rp 101,395
Tanda Tangan pajak Pnc Rp - TOTAL 2%

1% (BLUD)
total PNC Rp -
operasional
Tim Emrgncy Rp 1,262,250

Nama Nominal Pajak 2% Terima
dr Liliana Rp 420,750 Rp 63,113 ### Rp 7,153 Rp 350,484
Rokhani Rp 420,750 Rp 21,038 ### Rp 7,994 Rp 391,718
Haryati Rp 420,750 Rp 21,038 ### Rp 7,994 Rp 391,718
Rp 105,189 ### Rp 23,141
Ve Penolong PNC
vol vee total vee
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438

0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 871,889 Rp 17,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 471,889 Rp 9,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 471,889 Rp 9,438
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 10,000 Rp - Rp 550,000 Rp 11,000
Rp - Rp 2,447,000 Rp - Rp 4,797,000 Rp 95,940

1% (BLUD)
total PNC Rp -
operasional

Rp 92,250 ### Rp 20,295
Ve Penolong PNC
vol vee total vee
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719

0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 885,944 Rp 17,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 485,944 Rp 9,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 485,944 Rp 9,719
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp 100,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 10,000 Rp - Rp 650,000 Rp 13,000
Rp - Rp 2,573,500 Rp - Rp 5,323,500 Rp 100,470

1% (BLUD)
total PNC Rp -
operasional

Rp 102,375 ### Rp 22,523
Ve Penolong PNC
vol vee total vee
1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 1,155,639 Rp 23,113

0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 505,639 Rp 10,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 505,639 Rp 10,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 705,639 Rp 14,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 305,639 Rp 6,113
2 Rp 50,000 Rp 100,000 Rp 305,639 Rp - Rp 605,639 Rp 12,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 305,639 Rp 6,113
0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 1,705,639 Rp 34,113
0 Rp 50,000 Rp - Rp -
1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 355,639 Rp 7,113
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
4 Rp 10,000 Rp 40,000 Rp 840,000 Rp 16,800
Rp 240,000 Rp 2,750,750 Rp - Rp 6,990,750 Rp 139,815

1% (BLUD)
total PNC Rp -
operasional

Rp 134,439 ### Rp 29,576
Ve Penolong PNC
vol vee total vee
1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 1,144,917 Rp 22,898

0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 494,917 Rp 9,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 694,917 Rp 13,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,294,917 Rp 25,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 694,917 Rp 13,898
1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 744,917 Rp 14,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 494,917 Rp 9,898
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,694,917 Rp 33,898
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,094,917 Rp 21,898
0 Rp 50,000 Rp - Rp - Rp - Rp 400,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
2 Rp 10,000 Rp 20,000 Rp 1,220,000 Rp 24,400
Rp 120,000 Rp 4,454,250 Rp - Rp 9,974,250 Rp 191,485

1% (BLUD)
total PNC Rp -
operasional

Rp 191,814 ### Rp 42,199
Ve Penolong PNC
vol vee total vee
2 Rp 50,000 Rp 100,000 Rp 215,583 Rp - Rp 915,583 Rp 18,312

0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 615,583 Rp 12,312
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 615,583 Rp 12,312
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
2 Rp 10,000 Rp 20,000 Rp 620,000 Rp 12,400
Rp 120,000 Rp 1,940,250 Rp - Rp 5,060,250 Rp 93,205

1% (BLUD)
total PNC Rp -
operasional

Rp 97,314 ### Rp 21,409
Ve Penolong PNC
vol vee total vee
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664

0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 583,181 Rp 11,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
1 Rp 50,000 Rp 50,000 Rp 183,181 Rp - Rp 433,181 Rp 8,664
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664
0 Rp 50,000 Rp - Rp -
0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664
0 Rp 50,000 Rp - Rp - Rp - Rp 400,000 Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
0 Rp 50,000 Rp - Rp - Rp - Rp - Rp -
1 Rp 10,000 Rp 10,000 Rp 460,000 Rp 9,200
Rp 60,000 Rp 1,648,625 Rp - Rp 3,758,625 Rp 67,173

1% (BLUD)
total PNC Rp -
operasional
Tim Emrgncy Rp 867,375

Rp 72,281 ### Rp 15,902
TERIMA TANDA TANGAN
Rp 272,195 1
Rp 272,195 2
Rp 517,195 3
Rp 664,195 4
Rp 321,195 5
Rp 860,195 6
Rp 272,195 7
Rp 664,195 8
9
Rp 468,195 10
Rp 200,000 11
Rp 200,000 12
Rp - 13
Rp - 14
Rp 656,600 15
Rp 5,368,355
TANDA TANGAN
Rp 156,125
Rp 84,150
Rp 71,975
Tanda Tangan
1
2
3
TERIMA TANDA TANGAN
Rp 658,451 1
Rp 266,451 2
Rp 658,451 3
Rp 854,451 4
Rp 266,451 5
Rp 462,451 6
Rp 266,451 7
Rp 266,451 8
9
Rp 462,451 10
Rp - 11
Rp - 12
Rp - 13
Rp - 14
Rp 539,000 15
Rp 4,701,060
TANDA TANGAN
Rp 143,938
Rp 73,800
Rp 70,138
Tanda Tangan
1
2
3
TERIMA TANDA TANGAN
Rp 672,226 1
Rp 672,226 2
Rp 280,226 3
Rp 868,226 4
Rp 476,226 5
Rp 280,226 6
Rp 280,226 7
Rp 280,226 8
9
Rp 476,226 10
Rp 200,000 11
Rp - 12
Rp 100,000 13
Rp - 14
Rp 637,000 15
Rp 5,223,030
TANDA TANGAN
Rp 153,485
Rp 81,900
Rp 71,585
Tanda Tangan
1
2
3
TERIMA TANDA TANGAN
Rp 1,132,526 1
Rp 495,526 2
Rp 495,526 3
Rp 691,526 4
Rp 299,526 5
Rp 593,526 6
Rp 299,526 7
Rp 1,671,526 8
9
Rp 348,526 10
Rp - 11
Rp - 12
Rp - 13
Rp - 14
Rp 823,200 15
Rp 6,850,935
TANDA TANGAN
Rp 209,433
Rp 107,550
Rp 101,883
Tanda Tangan
1
2
3
TERIMA TANDA TANGAN
Rp 1,122,018 1
Rp 485,018 2
Rp 681,018 3
Rp 1,269,018 4
Rp 681,018 5
Rp 730,018 6
Rp 485,018 7
Rp 1,661,018 8
9
Rp 1,073,018 10
Rp 400,000 11
Rp - 12
Rp - 13
Rp - 14
Rp 1,195,600 15
Rp 9,782,765
TANDA TANGAN
Rp 290,814
Rp 153,450
Rp 137,364
Tanda Tangan
1
2
3
TERIMA TANDA TANGAN
Rp 897,272 1
Rp 211,272 2
Rp 407,272 3
Rp 407,272 4
Rp 407,272 5
Rp 211,272 6
Rp 211,272 7
Rp 603,272 8
9
Rp 603,272 10
Rp 200,000 11
Rp 200,000 12
Rp - 13
Rp - 14
Rp 607,600 15
Rp 4,967,045
TANDA TANGAN
Rp 143,598
Rp 77,850
Rp 65,748
Tanda Tangan
1
2
3
TERIMA TANDA TANGAN
Rp 375,517 1
Rp 375,517 2
Rp 179,517 3
Rp 571,517 4
Rp 179,517 5
Rp 179,517 6
Rp 424,517 7
Rp 179,517 8
9
Rp 375,517 10
Rp 400,000 11
Rp - 12
Rp - 13
Rp - 14
Rp 450,800 15
Rp 3,691,453
TANDA TANGAN
Rp 104,603
Rp 57,825
Rp 46,778
Tanda Tangan
1
2
3
persal Normal pra Rujukan TOTAL 2%
NAMA BULAN Ve Penolong PNC TERIMA TTD

vol vee total vee vol vee total vee
1. Haryati FEB '22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555 Rp 272,195

1. Haryati MAR'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438 Rp 658,451
1. Haryati APR'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719 Rp 672,226
1. Haryati MEI'22 4 Rp 200,000 Rp 800,000 1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 1,155,639 Rp 23,113 Rp 1,132,526
1. Haryati JUN'22 3 Rp 200,000 Rp 600,000 1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 1,144,917 Rp 22,898 Rp 1,122,018
1. Haryati JUL'22 3 Rp 200,000 Rp 600,000 2 Rp 50,000 Rp 100,000 Rp 215,583 Rp - Rp 915,583 Rp 18,312 Rp 897,272
1. Haryati AGS'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664 Rp 375,517
5130204.72
3. Rokhani FEB '22 1 Rp 200,000 Rp 200,000 1 Rp 50,000 Rp 50,000 Rp 277,750 Rp - Rp 527,750 Rp 10,555 Rp 517,195
3. Rokhani MAR'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438 Rp 658,451
3. Rokhani APR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719 Rp 280,226
3. Rokhani MEI'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 505,639 Rp 10,113 Rp 495,526
3. Rokhani JUN'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 694,917 Rp 13,898 Rp 681,018
3. Rokhani JUL'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312 Rp 407,272
3. Rokhani AGS'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664 Rp 179,517
Rp 3,219,205
2. Rusiyani FEB '22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555 Rp 272,195

2. Rusiyani MAR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438 Rp 266,451
2. Rusiyani APR'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719 Rp 672,226
2. Rusiyani MEI'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 505,639 Rp 10,113 Rp 495,526
2. Rusiyani JUN'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 494,917 Rp 9,898 Rp 485,018
2. Rusiyani JUL'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312 Rp 211,272
2. Rusiyani AGS'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664 Rp 375,517
Rp 2,778,205

4. Siti Salamah FEB '22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 677,750 Rp 13,555 Rp 664,195
4. Siti Salamah MAR'22 3 Rp 200,000 Rp 600,000 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 871,889 Rp 17,438 Rp 854,451
4. Siti Salamah APR'22 3 Rp 200,000 Rp 600,000 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 885,944 Rp 17,719 Rp 868,226
4. Siti Salamah MEI'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 705,639 Rp 14,113 Rp 691,526
4. Siti Salamah JUN'22 4 Rp 200,000 Rp 800,000 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,294,917 Rp 25,898 Rp 1,269,018
4. Siti Salamah JUL'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312 Rp 407,272
4. Siti Salamah AGS'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 583,181 Rp 11,664 Rp 571,517
Rp 5,326,205
5. Retno FEB '22 0 Rp 200,000 Rp - 1 Rp 50,000 Rp 50,000 Rp 277,750 Rp - Rp 327,750 Rp 6,555 Rp 321,195
5. Retno MAR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438 Rp 266,451
5. Retno APR'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 485,944 Rp 9,719 Rp 476,226
5. Retno MEI'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 305,639 Rp 6,113 Rp 299,526
5. Retno JUN'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 694,917 Rp 13,898 Rp 681,018
5. Retno JUL'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 415,583 Rp 8,312 Rp 407,272
5. Retno AGS'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664 Rp 179,517
Rp 2,631,205
6. Dyah E FEB '22 3 Rp 200,000 Rp 600,000 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 877,750 Rp 17,555 Rp 860,195
6. Dyah E MAR'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 471,889 Rp 9,438 Rp 462,451
6. Dyah E APR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719 Rp 280,226
6. Dyah E MEI'22 1 Rp 200,000 Rp 200,000 2 Rp 50,000 Rp 100,000 Rp 305,639 Rp - Rp 605,639 Rp 12,113 Rp 593,526
6. Dyah E JUN'22 1 Rp 200,000 Rp 200,000 1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 744,917 Rp 14,898 Rp 730,018
6. Dyah E JUL'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312 Rp 211,272
6. Dyah E AGS'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664 Rp 179,517
Rp 3,317,205

7. Nurul H FEB '22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555 Rp 272,195

7. Nurul H MAR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438 Rp 266,451
7. Nurul H APR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719 Rp 280,226
7. Nurul H MEI'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 305,639 Rp 6,113 Rp 299,526
7. Nurul H JUN'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 494,917 Rp 9,898 Rp 485,018
7. Nurul H JUL'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 215,583 Rp 4,312 Rp 211,272
7. Nurul H AGS'22 1 Rp 200,000 Rp 200,000 1 Rp 50,000 Rp 50,000 Rp 183,181 Rp - Rp 433,181 Rp 8,664 Rp 424,517
Rp 2,239,205
8.Nurwaeti FEB '22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 677,750 Rp 13,555 Rp 664,195
8.Nurwaeti MAR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 271,889 Rp 5,438 Rp 266,451
8.Nurwaeti APR'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 285,944 Rp 5,719 Rp 280,226
8.Nurwaeti MEI'22 7 Rp 200,000 Rp 1,400,000 0 Rp 50,000 Rp - Rp 305,639 Rp - Rp 1,705,639 Rp 34,113 Rp 1,671,526
8.Nurwaeti JUN'22 6 Rp 200,000 Rp 1,200,000 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,694,917 Rp 33,898 Rp 1,661,018
8.Nurwaeti JUL'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 615,583 Rp 12,312 Rp 603,272
8.Nurwaeti AGS'22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 183,181 Rp 3,664 Rp 179,517
Rp 5,326,205
10.Rosdiana FEB '22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 477,750 Rp 9,555 Rp 468,195
10.Rosdiana MAR'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 471,889 Rp 9,438 Rp 462,451
10.Rosdiana APR'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 485,944 Rp 9,719 Rp 476,226
10.Rosdiana MEI'22 0 Rp 200,000 Rp - 1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 355,639 Rp 7,113 Rp 348,526
10.Rosdiana JUN'22 3 Rp 200,000 Rp 600,000 0 Rp 50,000 Rp - Rp 494,917 Rp - Rp 1,094,917 Rp 21,898 Rp 1,073,018
10.Rosdiana JUL'22 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp 215,583 Rp - Rp 615,583 Rp 12,312 Rp 603,272
10.Rosdiana AGS'22 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664 Rp 375,517
Rp 3,807,205

11. Dyah R 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

11. Dyah R 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp - Rp - Rp - Rp - Rp -
11. Dyah R 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp - Rp - Rp 400,000 Rp - Rp 400,000
11.Dyah Rina 2 Rp 200,000 Rp 400,000 0 Rp 50,000 Rp - Rp - Rp - Rp 400,000 Rp - Rp 400,000
Rp 1,000,000
11. Endang 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

Rp 200,000
11.Tri 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

Rp 200,000
12.Ida 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

Rp 200,000
13.Kamini 1 Rp 100,000 Rp 100,000 0 Rp 50,000 Rp - Rp - Rp - Rp 100,000 Rp - Rp 100,000

Rp 100,000
12.Rumini 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

Rp 200,000
15.Kary.BLUD FEB '22 13 Rp 50,000 Rp 650,000 2 Rp 10,000 Rp 20,000 Rp 670,000 Rp 13,400 Rp 656,600
15.Kary.BLUD MAR'22 11 Rp 50,000 Rp 550,000 0 Rp 10,000 Rp - Rp 550,000 Rp 11,000 Rp 539,000
15.Kary.BLUD APR'22 13 Rp 50,000 Rp 650,000 0 Rp 10,000 Rp - Rp 650,000 Rp 13,000 Rp 637,000
15.Kary.BLUD MEI'22 16 Rp 50,000 Rp 800,000 4 Rp 10,000 Rp 40,000 Rp 840,000 Rp 16,800 Rp 823,200
15.Kary.BLUD JUN'22 24 Rp 50,000 Rp 1,200,000 2 Rp 10,000 Rp 20,000 Rp 1,220,000 Rp 24,400 Rp 1,195,600
15.Kary.BLUD JUL'22 12 Rp 50,000 Rp 600,000 2 Rp 10,000 Rp 20,000 Rp 620,000 Rp 12,400 Rp 607,600
15.Kary.BLUD AGS'22 9 Rp 50,000 Rp 450,000 1 Rp 10,000 Rp 10,000 Rp 460,000 Rp 9,200 Rp 450,800
Rp 41,374,125 Rp 789,483 Rp 4,909,800
40,584,642.50
Rp 40,584,642
Rokhani Rp 420,750 Rp 21,038 Rp 399,712 Rp 7,994 Rp 391,718 2
Nama Nominal Pajak 2% Terima bulan
dr Liliana Rp 420,750 Rp 63,113 Rp 357,637 Rp 7,153 Rp 350,484 feb
dr Liliana Rp 369,000 Rp 55,350 Rp 313,650 Rp 6,273 Rp 307,377 mar
dr Liliana Rp 409,500 Rp 61,425 Rp 348,075 Rp 6,962 Rp 341,114 apr
dr Liliana Rp 537,750 Rp 80,663 Rp 457,087 Rp 9,142 Rp 447,945 mei
dr Liliana Rp 767,250 Rp 115,088 Rp 652,162 Rp 13,043 Rp 639,119 jun
dr Liliana Rp 389,250 Rp 58,388 Rp 330,862 Rp 6,617 Rp 324,245 jul
dr Liliana Rp 289,125 Rp 43,369 Rp 245,756 Rp 4,915 Rp 240,841 ags
Rp 3,182,625 Rp 2,705,229 Rp 54,105 Rp 2,651,124

Haryati Rp 420,750 Rp 21,038 Rp 399,712 Rp 7,994 Rp 391,718 feb
Haryati Rp 369,000 Rp 18,450 Rp 350,550 Rp 7,011 Rp 343,539 mar
Haryati Rp 409,500 Rp 20,475 Rp 389,025 Rp 7,781 Rp 381,245 apr
Haryati Rp 537,750 Rp 26,888 Rp 510,862 Rp 10,217 Rp 500,645 mei
Haryati Rp 767,250 Rp 38,363 Rp 728,887 Rp 14,578 Rp 714,309 jun
Haryati Rp 389,250 Rp 19,463 Rp 369,787 Rp 7,396 Rp 362,391 jul
Haryati Rp 289,125 Rp 14,456 Rp 274,669 Rp 5,493 Rp 269,176 ags
Rp 3,023,492 Rp 60,470 Rp 2,963,022

Rokhani Rp 420,750 Rp 21,038 Rp 399,712 Rp 7,994 Rp 391,718 feb
Rokhani Rp 369,000 Rp 18,450 Rp 350,550 Rp 7,011 Rp 343,539 mar
Rokhani Rp 409,500 Rp 20,475 Rp 389,025 Rp 7,781 Rp 381,245 apr
Rokhani Rp 537,750 Rp 26,888 Rp 510,862 Rp 10,217 Rp 500,645 mei
Rokhani Rp 767,250 Rp 38,363 Rp 728,887 Rp 14,578 Rp 714,309 jun
Rokhani Rp 389,250 Rp 19,463 Rp 369,787 Rp 7,396 Rp 362,391 jul
Rokhani Rp 289,125 Rp 14,456 Rp 274,669 Rp 5,493 Rp 269,176 ags
Rp 3,023,492 Rp 60,470 Rp 2,963,022
Rekening 2% Terima
BIDAN Rp 6,046,984 Rp 120,940 Rp 5,926,044
Operasional Pkm Rp 1,683,000 Tanda Tangan
pajak Rp 103,568
terima Rp 1,579,432 2% Rp 31,589
dr.visite 15 Rp 5,000 Rp 75,000
Tanda Tangan
TOTAL KLAIM Rp 8,415,000 Tim Emrgncy
TOTAL PAJAK Rp 208,757 Nama Nominal
1% (BLUD) Rp 84,150 Umi Kulsum dr Liliana ###
Rokhani ###
Haryati ###

pajak Rp 90,832
terima Rp 1,385,168 2% Rp 27,703
dr.visite 11 Rp 5,000 Rp 55,000
Tanda Tangan
Rokhani ###
Haryati ###

pajak Rp 113,400
terima Rp 1,524,600 2% Rp 30,492
dr.visite 13 Rp 5,000 Rp 65,000
Tanda Tangan
Rokhani ###
Haryati ###

pajak Rp 148,914
terima Rp 2,002,086 2% Rp 40,042
dr.visite 20 Rp 5,000 Rp 100,000
Tanda Tangan
Rokhani ###
Haryati ###

pajak Rp 212,472
terima Rp 2,856,528 2% Rp 57,131
dr.visite 26 Rp 5,000 Rp 130,000
Tanda Tangan
Umi Kulsum
Rokhani ###
Haryati ###

pajak Rp 107,787
terima Rp 1,449,213 2% Rp 28,984
dr.visite 14 Rp 5,000 Rp 70,000
Tanda Tangan
Rokhani ###
Haryati ###

pajak Rp 80,064
terima Rp 1,076,436 2% Rp 21,529
dr.visite 10 Rp 5,000 Rp 50,000
Tanda Tangan
Rokhani ###
Haryati ###
pajak Pnc Rp - TOTAL 2% Rp 156,125
1% (BLUD) Rp 84,150
total PNC Rp -
operasiona Rp 71,975
###
Pajak 2% Terima Tanda Tangan
### ### Rp 7,153 ### 1
### ### Rp 7,994 ### 2
### ### Rp 7,994 ### 3
### ### ###

1% (BLUD) Rp 73,800
total PNC Rp -
###
### ### Rp 6,273 ### 1
### ### Rp 7,011 ### 2
### ### Rp 7,011 ### 3
### ### ###

1% (BLUD) Rp 81,900
total PNC Rp -
###
### ### Rp 6,962 ### 1
### ### Rp 7,781 ### 2
### ### Rp 7,781 ### 3
### ### ###

1% (BLUD) Rp 107,550
total PNC Rp -
###
### ### Rp 9,142 ### 1
### ### ### ### 2
### ### ### ### 3
### ### ###

1% (BLUD) Rp 153,450
total PNC Rp -
###
### ### ### ### 1
### ### ### ### 2
### ### ### ### 3
### ### ###

1% (BLUD) Rp 77,850
total PNC Rp -
###
### ### Rp 6,617 ### 1
### ### Rp 7,396 ### 2
### ### Rp 7,396 ### 3
### ### ###

1% (BLUD) Rp 57,825
total PNC Rp -
###
### ### Rp 4,915 ### 1
### ### Rp 5,493 ### 2
### ### Rp 5,493 ### 3
### ### ###
nom pajak rek
Operasional Pkm Rp 1,683,000 feb Rp 103,568 Rp 1,579,432 2% Rp 31,589 Rp 1,547,843 Rp 832,379
Operasional Pkm Rp 1,476,000 mar Rp 90,832 Rp 1,385,168 2% Rp 27,703 Rp 1,357,465 Rp 856,679
Operasional Pkm Rp 1,638,000 apr Rp 113,400 Rp 1,524,600 2% Rp 30,492 Rp 1,494,108 Rp 832,379
Operasional Pkm Rp 2,151,000 mei Rp 148,914 Rp 2,002,086 2% Rp 40,042 Rp 1,962,044 Rp 930,306
Operasional Pkm Rp 3,069,000 jun Rp 212,472 Rp 2,856,528 2% Rp 57,131 Rp 2,799,397 Rp 930,306
Operasional Pkm Rp 1,557,000 jul Rp 107,787 Rp 1,449,213 2% Rp 28,984 Rp 1,420,229 Rp 930,306
Operasional Pkm Rp 1,156,500 ags Rp 80,064 Rp 1,076,436 2% Rp 21,529 Rp 1,054,907 Rp 930,306
Rp 12,730,500 Rp 857,037 Rp 11,873,463 Rp 237,469 Rp 11,635,994 Rp 11,035,994 Rp 930,306
Rp 930,306
Rp 930,306
dr Sigit dr Asyifa dr.Puji Rp 930,306
dr.visite feb 15 Rp 5,000 Rp 75,000 Rp250,000 Rp250,000 Rp100,000 Rp600,000 Rp 930,306
dr.visite mar 11 Rp 5,000 Rp 55,000 Rp 979,269
dr.visite apr 13 Rp 5,000 Rp 65,000 Rp 11,873,460
dr.visite mei 20 Rp 5,000 Rp 100,000
dr.visite jun 26 Rp 5,000 Rp 130,000
dr.visite jul 14 Rp 5,000 Rp 70,000
dr.visite ags 10 Rp 5,000 Rp 50,000
Rp 545,000
Ops Lain Rp 71,975 feb 1% (BLUD) Rp 84,150 feb TOTAL 2% Rp 156,125 feb
Ops Lain Rp 70,138 mar 1% (BLUD) Rp 73,800 mar TOTAL 2% Rp 143,938 mar
Ops Lain Rp 71,585 apr 1% (BLUD) Rp 81,900 apr TOTAL 2% Rp 153,485 apr
Ops Lain Rp 101,883 mei 1% (BLUD) Rp 107,550 mei TOTAL 2% Rp 209,433 mei
Ops Lain Rp 137,364 jun 1% (BLUD) Rp 153,450 jun TOTAL 2% Rp 290,814 jun
Ops Lain Rp 65,748 jul 1% (BLUD) Rp 77,850 jul TOTAL 2% Rp 143,598 jul
Ops Lain Rp 46,778 ags 1% (BLUD) Rp 57,825 ags TOTAL 2% Rp 104,603 ags
Rp 565,471 Rp 636,525 Rp 1,201,996
dr Sigit dr Asyifa dr.Puji
dr.visite feb 15 Rp 5,000 Rp 75,000 Rp250,000 Rp250,000 Rp100,000
dr.visite mar 11 Rp 5,000 Rp 55,000
dr.visite apr 13 Rp 5,000 Rp 65,000
dr.visite mei 20 Rp 5,000 Rp 100,000
dr.visite jun 26 Rp 5,000 Rp 130,000
dr.visite jul 14 Rp 5,000 Rp 70,000
dr.visite ags 10 Rp 5,000 Rp 50,000
Rp 545,000

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PEMBAGIAN JASA PERSALINAN PBI,NO

klaim persal Rp 8,415,000

pra Rujukan TOTAL 2%

0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555

Operasional Pkm Rp 1,683,000

1. Haryati 2 Rp 200,000 Rp 400,000

Operasional Pkm Rp 1,476,000

klaim persal +pra Rp 8,190,000

1. Haryati 2 Rp 200,000 Rp 400,000

Operasional Pkm Rp 1,638,000

klaim persal +pra Rp 10,755,000

1. Haryati 4 Rp 200,000 Rp 800,000

Operasional Pkm Rp 2,151,000

klaim persal +pra Rp 15,345,000

1. Haryati 3 Rp 200,000 Rp 600,000

Operasional Pkm Rp 3,069,000

1. Haryati 3 Rp 200,000 Rp 600,000

Operasional Pkm Rp 1,557,000

klaim persal +pra Rp 5,782,500

1. Haryati 1 Rp 200,000 Rp 200,000

Operasional Pkm Rp 1,156,500

pra Rujukan TOTAL 2%

0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 1,262,250

0 Rp 50,000 Rp - Rp 271,889 Rp - Rp 671,889 Rp 13,438

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 1,107,000

0 Rp 50,000 Rp - Rp 285,944 Rp - Rp 685,944 Rp 13,719

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 1,228,500

1 Rp 50,000 Rp 50,000 Rp 305,639 Rp - Rp 1,155,639 Rp 23,113

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 1,613,250

pra Rujukan TOTAL 2%

1 Rp 50,000 Rp 50,000 Rp 494,917 Rp - Rp 1,144,917 Rp 22,898

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 2,301,750

pra Rujukan TOTAL 2%

2 Rp 50,000 Rp 100,000 Rp 215,583 Rp - Rp 915,583 Rp 18,312

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 1,167,750

pra Rujukan TOTAL 2%

0 Rp 50,000 Rp - Rp 183,181 Rp - Rp 383,181 Rp 7,664

Tanda Tangan pajak Pnc Rp - TOTAL 2%

Tim Emrgncy Rp 867,375

TERIMA TANDA TANGAN

TERIMA TANDA TANGAN

NAMA BULAN Ve Penolong PNC TERIMA TTD

1. Haryati FEB '22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555 Rp 272,195

2. Rusiyani FEB '22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555 Rp 272,195

NAMA BULAN Ve Penolong PNC TERIMA TTD

NAMA BULAN Ve Penolong PNC TERIMA TTD

7. Nurul H FEB '22 0 Rp 200,000 Rp - 0 Rp 50,000 Rp - Rp 277,750 Rp - Rp 277,750 Rp 5,555 Rp 272,195

NAMA BULAN Ve Penolong PNC TERIMA TTD

11. Dyah R 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

11. Endang 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

11.Tri 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

12.Ida 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

13.Kamini 1 Rp 100,000 Rp 100,000 0 Rp 50,000 Rp - Rp - Rp - Rp 100,000 Rp - Rp 100,000

12.Rumini 1 Rp 200,000 Rp 200,000 0 Rp 50,000 Rp - Rp - Rp - Rp 200,000 Rp - Rp 200,000

Nama Nominal Pajak 2% Terima bulan

Nama Nominal Pajak 2% Terima bulan

Operasional Pkm Rp 1,476,000 Tanda Tangan