Account Statement: Account No. Account Type

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ACCOUNT STATEMENT RUMAH SAKIT RAFFLESIA

Account No. Account Type Period Page

JL MAHONI NO 10 PADANG JATI

Posting Date

Effective Date

Branch

Journal

: 72005233 - RUMAH SAKIT RAFFLESIA : Current : 01-Apr-18

- 23-Apr-18

: 1

Transaction Description

Amount

DB/CR

Ledger Balance: DIVISI OPERASIO NAL DIVISI OPERASIO NAL DIVISI OPERASIO NAL DIVISI OPERASIO NAL DIVISI OPERASIO NAL DIVISI TRANSACTI ONAL BANKING SERVICES (TBS)

02/04/2018 10.20.07

02/04/2018 10.20.07

02/04/2018 10.20.07

02/04/2018 10.20.07

02/04/2018 15.47.49

02/04/2018 15.47.49

02/04/2018 16.54.11

02/04/2018 16.54.11

02/04/2018 16.54.11

02/04/2018 16.54.11

04/04/2018 11.34.05

04/04/2018 11.34.05

04/04/2018 13.02.39

04/04/2018 13.02.39

04/04/2018 13.02.39

04/04/2018 13.02.39

06/04/2018 10.47.01

06/04/2018 10.47.01

DIVISI OPERASIO NAL DIVISI OPERASIO NAL BENGKULU

06/04/2018 10.47.28

06/04/2018 10.47.28

BENGKULU

06/04/2018 10.52.23

06/04/2018 10.52.23

BENGKULU

06/04/2018 11.03.21

06/04/2018 11.03.21

DIVISI TRANSACTI ONAL BANKING SERVICES

Balance 41,185,796.00

732263 KREDIT LAIN-LAIN | 008 TRITUNGGAL MAND PROVIDER 732282 KREDIT LAIN-LAIN | 008 KARTIKA BINA ME 611SKeuRSRBII2018 624987 KREDIT LAIN-LAIN | 011 ASURANSI ADIRA KLAIMPCM 003532038696 148730 KREDIT LAIN-LAIN | 008 TRITUNGGAL MAND 148740 KREDIT LAIN-LAIN | 031 PT AVRIST ASSUR OP AVRIST PROVIDER EOB 270318 995569 TRANSFER DARI | PEMINDAHAN DARI 91540405 BNI LIFE INSURANCE PT / CAB. | MAYA YULIAH, RAHMATIN NADIA TRF TO:000000000072 430449 KREDIT LAIN-LAIN | 013 ASURANSI ASTRA RS Rafflesia Bengku/ 00048/04 430477 KREDIT LAIN-LAIN | 013 ASURANSI ASTRA RS Rafflesia Bengku/ 00048/04 216312 SETOR TUNAI | Sdr DANIAL LIPURA | SETORAN TGL 2831/3/2018 223360 SETOR TUNAI | Sdr DANIAL LIPURA | SETORAN TGL 01/04/2018 298498 TARIK CHQ CG025818 | DANIAL LIPURA/383718559 449998 TRANSFER DARI | PEMINDAHAN DARI 609888880 LIPPO GENERAL INSURANCE | 0072005233

8,054,876.00 0.00

K

49,240,672.00

216,175.00 0.00

K

49,456,847.00

1,814,632.00 0.00

K

51,271,479.00

1,578,333.00 0.00

K

52,849,812.00

600,604.00 0.00

K

53,450,416.00

11,556,708.00 0.00

K

65,007,124.00

133,755.00 0.00

K

65,140,879.00

113,525.00 0.00

K

65,254,404.00

127,381,544.00 0.00

K

192,635,948.00

12,212,516.00 0.00

K

204,848,464.00

44,957,048.00

D

159,891,416.00

3,456,860.00 0.00

K

163,348,276.00

ACCOUNT STATEMENT RUMAH SAKIT RAFFLESIA JL MAHONI NO 10 PADANG JATI

Posting Date

Effective Date

Account No. Account Type Period Page

Branch

Journal

: 72005233 - RUMAH SAKIT RAFFLESIA : Current : 01-Apr-18

- 23-Apr-18

: 2

Transaction Description

20180406457875446 | Lippo Insurance (05 Apr 2018) | SYARIAH 144383 TRANSFER DARI | JAKARTA KU.26/07/20/JPK.JKT-2018 | UTARA PEMINDAHAN DARI 8200000899 JKS SIMSEM RS PELABUHAN JK | PBY HUTANG YANKES PESERTA BAPEL JPKM RSP DIVISI 014915 KREDIT LAIN-LAIN | 016 ASURANSI SINAR OPERASIO NAL DIVISI 096234 KREDIT LAIN-LAIN | 016 PT.ASURANSI SIN OPERASIO NAL DIVISI 096250 KREDIT LAIN-LAIN | 008 YKP OJK 621/S.KEU/RSRB OPERASIO NAL DIVISI 482100 TRANSFER DARI | TRANSACTI PEMINDAHAN DARI ONAL 101407068 BNI LIFE BANKING INSURANCE.PT | 0072005233 SERVICES 201804091724072500 | (TBS) HERLINA YULIASTRI |1485LY10

Amount

DB/CR

Balance

(TBS)

06/04/2018 13.33.42

06/04/2018 13.33.42

06/04/2018 15.55.19

06/04/2018 15.55.19

09/04/2018 17.38.58

09/04/2018 17.38.58

09/04/2018 17.38.58

09/04/2018 17.38.58

09/04/2018 18.11.43

09/04/2018 18.11.43

10/04/2018 10.27.51

10/04/2018 10.27.51

10/04/2018 13.52.10

10/04/2018 15.40.48

10/04/2018 17.52.55

DIVISI OPERASIO NAL DIVISI 10/04/2018 13.52.10 OPERASIO NAL DIVISI 10/04/2018 15.40.48 OPERASIO NAL DIVISI 10/04/2018 17.52.55 TRANSACTI ONAL BANKING SERVICES (TBS)

330565 KREDIT LAIN-LAIN | 016 ASURANSI SINAR CIPTARINI PURNAMA S 139001 KREDIT LAIN-LAIN | 008 PT PLN (PERSERO P3BS3 140487 KREDIT LAIN-LAIN | 067 ASURANSI ALLIAN 905830CLM PAY HLTH FRM ALLIAN 344574 TRANSFER DARI | PEMINDAHAN DARI 119352653 BNI LIFE INSURANCE, PT | 0072005233 201804101099942381 | BNILIFE PROV

558,726.00 0.00

K

163,907,002.00

112,125.00 0.00

K

164,019,127.00

787,172.00 0.00

K

164,806,299.00

347,633.00 0.00

K

165,153,932.00

18,201,948.00 0.00

K

183,355,880.00

2,850,350.00 0.00

K

186,206,230.00

3,576,342.00 0.00

K

189,782,572.00

160,062.00 0.00

K

189,942,634.00

5,359,802.00 0.00

K

195,302,436.00

ACCOUNT STATEMENT RUMAH SAKIT RAFFLESIA JL MAHONI NO 10 PADANG JATI

Posting Date

Effective Date

11/04/2018 10.12.15

11/04/2018 10.12.15

11/04/2018 11.48.42

11/04/2018 11.48.42

11/04/2018 11.48.42

11/04/2018 11.48.42

11/04/2018 13.55.28

11/04/2018 13.55.28

11/04/2018 17.36.34

11/04/2018 17.36.34

12/04/2018 09.53.31

12/04/2018 09.53.31

12/04/2018 16.05.45

12/04/2018 16.05.45

13/04/2018 10.46.24

13/04/2018 10.46.24

13/04/2018 13.40.59

13/04/2018 13.40.59

13/04/2018 13.52.41

13/04/2018 13.52.41

13/04/2018 16.15.30

13/04/2018 16.15.30

Account No. Account Type Period Page

Branch

Journal

: 72005233 - RUMAH SAKIT RAFFLESIA : Current : 01-Apr-18

- 23-Apr-18

: 3

Transaction Description

|1510LY15 DIVISI 137715 KREDIT LAIN-LAIN | 008 OPERASIO ASURANSI JIWA I NAL 901/S.KEU/RSRB/III /2018 DIVISI 752352 KREDIT LAIN-LAIN | 067 OPERASIO HANJAYA MANDALA NAL 2500602831,EXCESS MBA ID804165 DIVISI 752365 KREDIT LAIN-LAIN | 067 OPERASIO HANJAYA MANDALA NAL MT180403MB162148,PERIAN SAH-02. DIVISI 795346 KREDIT LAIN-LAIN | 008 FWD OPERASIO LIFE INDONE FWD CLAIM NAL FIN/0668/ DIVISI 389977 TRANSFER DARI | TRANSACTI PEMINDAHAN DARI ONAL 101407068 BNI LIFE BANKING INSURANCE.PT | 0072005233 SERVICES 201804111506072011 | (TBS) YUNIARSIH |0001522.PCLNK56 DIVISI 469222 KREDIT LAIN-LAIN | 008 TRITUNGGAL MAND OPERASIO NAL DIVISI 797036 KREDIT LAIN-LAIN | 008 OPERASIO SARANA USAHA SE RS NAL RS BENGKULU 417805 TRANSFER DARI | PEMINDAHAN DARI 2230005671 SIMSEM GIRO INTERNAL - LAI | BPJS KESEHATAN BENGKULU 539777 SETOR TUNAI | Sdr DANIAL LIPURA BENGKULU 725571 TARIK CHQ CG025819 | DANIAL DIVISI 320211 TRANSFER DARI | TRANSACTI PEMINDAHAN DARI ONAL 210233968 PT ASURANSI

Amount

DB/CR

Balance

279,348.00 0.00

K

195,581,784.00

515,522.00 0.00

K

196,097,306.00

5,994,279.00 0.00

K

202,091,585.00

3,107,046.00 0.00

K

205,198,631.00

454,897.00 0.00

K

205,653,528.00

9,331,613.00 0.00

K

214,985,141.00

269,654.00 0.00

K

215,254,795.00

1,623,999,600.00 0.00

K

1,839,254,395.00

77,293,879.00 0.00

K

1,916,548,274.00

897,824,110.00

D

1,018,724,164.00

2,235,735.00 0.00

K

1,020,959,899.00

ACCOUNT STATEMENT RUMAH SAKIT RAFFLESIA JL MAHONI NO 10 PADANG JATI

Posting Date

Effective Date

Account No. Account Type Period Page

Branch

Journal

BANKING SERVICES (TBS)

: 72005233 - RUMAH SAKIT RAFFLESIA : Current : 01-Apr-18

- 23-Apr-18

: 4

Transaction Description UMUM MEGA | 0072005233 201804131430729250 | KLAIMHEALTHAUM | KREDIT LAIN-LAIN | 422 ASURANSI SINAR PAULA CORNELIA KREDIT LAIN-LAIN | 008 ASURANSI BINA D ABDACLAIM 000000000 TRANSFER DARI | PEMINDAHAN DARI 2230005671 SIMSEM GIRO INTERNAL - LAI | BPJS KESEHATAN TARIK CHQ/BG RTGS/FEE CG025820 | BERTHY SOERACHIM | OPERASIONAL YAYASAN APRIL 2018

13/04/2018 16.39.47

13/04/2018 16.39.47

13/04/2018 16.39.47

13/04/2018 16.39.47

16/04/2018 09.50.05

16/04/2018 09.50.05

DIVISI 647443 OPERASIO NAL DIVISI 647451 OPERASIO NAL BENGKULU 345422

16/04/2018 10.46.56

16/04/2018 10.46.56

BENGKULU 412237

16/04/2018 10.55.22

16/04/2018 10.55.22

16/04/2018 10.59.22

16/04/2018 10.59.22

BENGKULU 541989 KOR TARIK CHQ/BG RTGS/CG025820 BENGKULU 606622 TARIK CHQ/BG RTGS/FEE CG025820 | BERTHY SOERACHIM | OPERASIONAL YAYASAN APRIL 2018

16/04/2018 15.49.33

16/04/2018 15.49.33

17/04/2018 09.37.40

17/04/2018 09.37.40

17/04/2018 10.29.51

17/04/2018 10.29.51

17/04/2018 10.29.51

17/04/2018 10.29.51

17/04/2018 15.32.58

17/04/2018 15.32.58

DIVISI 652266 KREDIT LAIN-LAIN | 014 PT OPERASIO AJ CENTRAL A AF- T.282539 NAL KW NPT.AJ.CAR BENGKULU 149504 TARIK CHQ CG025822 | DANIAL/383718559 DIVISI 052083 KREDIT LAIN-LAIN | 013 OPERASIO ASURANSI RELIAN RS. NAL RAFFLESIA RELI 18031429907 DIVISI 052106 KREDIT LAIN-LAIN | 008 OPERASIO ASURANSI SINAR RIO NAL NICOLAS V BENGKULU 765066 TARIK CHQ/BG BF047239 | PEMINDAHAN KE

Amount

DB/CR

Balance

291,450.00 0.00

K

1,021,251,349.00

488,982.00 0.00

K

1,021,740,331.00

1,309,395,400.00 0.00

K

2,331,135,731.00

133,658,768.00

D

2,197,476,963.00

133,658,768.00 0.00

K

2,331,135,731.00

133,658,764.00

D

2,197,476,967.00

282,539.00 0.00

K

2,197,759,506.00

267,317,528.00

D

1,930,441,978.00

193,550.00 0.00

K

1,930,635,528.00

630,000.00 0.00

K

1,931,265,528.00

16,144,854.00

D

1,915,120,674.00

ACCOUNT STATEMENT RUMAH SAKIT RAFFLESIA JL MAHONI NO 10 PADANG JATI

Posting Date

Effective Date

Account No. Account Type Period Page

Branch

Journal

: 72005233 - RUMAH SAKIT RAFFLESIA : Current : 01-Apr-18

- 23-Apr-18

: 5

Transaction Description 263666844 PURNA KARYA MEDIKALINDO , P | PURNA KARYA MEDIKALINDO/NOVERWITA TARIK KLIRING BF047233 TARIK KLIRING BF047232 TARIK KLIRING BF047230 TARIK KLIRING BF047226 TARIK KLIRING BF047241 TARIK CHQ CG025823 | danial lipura KREDIT LAIN-LAIN | 008 NAYAKA ERA HUSA

18/04/2018 11.39.43

18/04/2018 11.39.43

BENGKULU 097765

18/04/2018 11.41.43

18/04/2018 11.41.43

BENGKULU 128130

18/04/2018 11.42.50

18/04/2018 11.42.50

BENGKULU 141784

18/04/2018 11.44.20

18/04/2018 11.44.20

BENGKULU 160361

18/04/2018 11.46.03

18/04/2018 11.46.03

BENGKULU 182244

18/04/2018 12.43.12

18/04/2018 12.43.12

BENGKULU 123924

18/04/2018 12.43.58

18/04/2018 12.43.58

18/04/2018 13.21.32

18/04/2018 13.21.32

18/04/2018 14.21.32

18/04/2018 14.21.32

18/04/2018 16.20.20

18/04/2018 16.20.20

18/04/2018 16.31.38

18/04/2018 16.31.38

19/04/2018 11.23.57

19/04/2018 11.23.57

DIVISI 133006 OPERASIO NAL BENGKULU 577096 TARIK CHQ CG025812 | AHMAD SUPRIYADI/0657404326 BENGKULU 552038 TARIK CHQ/BG BF047235 | PEMINDAHAN KE 295374864 MEDLAB NUSANTARA JL 473383 TRANSFER DARI | PERINTIS PEMINDAHAN DARI KEMERDEK 269360209904704 | AAN 0000000000000000 MITRA YAKES APR2 JL 603561 TRANSFER KE | PERINTIS PEMINDAHAN KE KEMERDEK 269360209904704 | AAN 0269360209904704 BIAYA MITRA APR 02 BENGKULU 296541 TRANSFER KE | PEMINDAHAN KE 223360193104012 | RUMAH SAKIT RAFFLESIA BENGKULU

Amount

DB/CR

Balance

20,331,361.00

D

1,894,789,313.00

13,009,002.00

D

1,881,780,311.00

8,171,401.00

D

1,873,608,910.00

68,085,991.00

D

1,805,522,919.00

277,480,037.00

D

1,528,042,882.00

207,939,452.00

D

1,320,103,430.00

896,569.00 0.00

K

1,320,999,999.00

98,812,500.00

D

1,222,187,499.00

58,943,650.00

D

1,163,243,849.00

1,441,004.00 0.00

K

1,164,684,853.00

5,000.00

D

1,164,679,853.00

100,000.00

D

1,164,579,853.00

ACCOUNT STATEMENT RUMAH SAKIT RAFFLESIA

Account No. Account Type Period Page

JL MAHONI NO 10 PADANG JATI

Posting Date

Effective Date

19/04/2018 11.42.01

19/04/2018 11.42.01

19/04/2018 12.05.51

19/04/2018 12.05.51

19/04/2018 12.07.17

19/04/2018 12.07.17

19/04/2018 12.07.39

19/04/2018 12.07.39

19/04/2018 12.10.16

19/04/2018 12.10.16

19/04/2018 15.02.11

19/04/2018 15.02.11

20/04/2018 10.48.23

20/04/2018 10.48.23

20/04/2018 11.23.43

20/04/2018 11.23.43

20/04/2018 11.26.16

20/04/2018 11.26.16

20/04/2018 11.31.40

20/04/2018 11.31.40

20/04/2018 11.35.58

20/04/2018 11.35.58

20/04/2018 11.49.39

20/04/2018 11.49.39

Branch

Journal

: 72005233 - RUMAH SAKIT RAFFLESIA : Current : 01-Apr-18

- 23-Apr-18

: 6

Transaction Description

DIVISI 535654 KREDIT LAIN-LAIN | 008 OPERASIO BERTHY SOERACHI NAL PENGEMBELIAN UANG AMBULANCE BENGKULU 065848 TARIK KLIRING BF047228 BENGKULU 084685 TARIK KLIRING BF047240 BENGKULU 089741 TARIK KLIRING BF047229 BENGKULU 122425 TARIK KLIRING BF047231 BENGKULU 626389 TARIK CHQ/BG BF047237 | PEMINDAHAN KE 70568968 MILLENNIUM PHARMACON INTERNA | MILLENNIUM PHARMACON INTERNATIONAL DIVISI 163327 KREDIT LAIN-LAIN | 008 OPERASIO ASURANSI JIWA I NAL 1358/S.KEU/RSRB/IV /2018 BENGKULU 630748 SETOR TUNAI | Sdr ERWIN SAHADI CF995226 BENGKULU 667842 TARIK CHQ | ERWIN BENGKULU 737184 TARIK CHQ CG025825 | ERWIN BENGKULU 788194 TARIK KLIRING BF047227 MELAWAI 181815 SETOR TUNAI | PT GLOBAL RAYA ASSITANCE

Ending Balance :

Amount

DB/CR

Balance

7,500,000.00 0.00

K

1,172,079,853.00

15,019,137.00

D

1,157,060,716.00

8,670,530.00

D

1,148,390,186.00

31,110,440.00

D

1,117,279,746.00

73,968,792.00

D

1,043,310,954.00

7,707,370.00

D

1,035,603,584.00

132,123.00 0.00

K

1,035,735,707.00

130,674,790.00 0.00

K

1,166,410,497.00

109,396,135.00

D

1,057,014,362.00

89,888,916.00

D

967,125,446.00

10,137,199.00

D

956,988,247.00

167,000.00 0.00

K 957,155,247.00

Total Debet : 24

2,592,337,985.00

Total Credit : 43

3,508,307,436.00

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