PT.

SEJAHTERA SENTOSA
Kepada Yth.
PEDAGANG BESAR FARMASI IZIN NO. HK. 09.06 / V / 324/ 13
Phone : (0354) 235234578 Apotek WIJAYA FARMA
NPWP :N 87524.458744.
FAKTUR Jl. Soekarno Hatta , Karngsoko TG
Nomor Dok : 05134 Hal : 1/1
TANGGAL JATUH TEMPO : 17-3-2018
PT. SEJAHTERA SENTOSA
Tanggal Dok : 17/02/2018 Jl. Bandar Lor no 36, Trenggalek
No. Ord/Sales : 00069/st NPWP PEMBELI : 24.536.34.54.001
P2T/32/24324./353/V/46

No. Batch ED UNIT Nama Produk Harga Satuan Rp. Jumlah % Potongan
HB
00336 08.19 12 fls Sanmol syr 15000 180000 5 9000

OIU34 12.18 1 bx Sanmol tablet 200000 200000 5 10000

Total I 380000
Terbilang : Tiga Ratus Sembilan Puluh Tujuh Ribu Seratus Rupiah
% DISK 19000
Total II 361000
IIN/IMA 02/03/17 07.05
Penerima PPN 36100
CATATAN :
Materai 0
Faktur Asli merupakan bukti
prembayaran yang sah TOTAL 397100
(.............................................)
Esti Widyan Rini, S.Farm., Apt
503/05222 SIK/ 419.64/2014 ASLI

DOT
Delivery On Time
EKSPRES
TRAVEL PAKET
Jl. Mentawai 65 – Malang
Telp. (0341) 636343. 4636
042342
PENGIRIM : ..................................................................................................PENERIMA : ..................................................................................................
ALAMAT : .................................................................................................... ALAMAT : ....................................................................................................
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KOTA : ...........................................................TELP. .................................. KOTA : ...........................................................TELP. ..................................

KETERANGAN BARANG KOLI BERAT DOKUMEN PAKET BIAYA

Tanggal : Tanda Tangan Tanggal : Tanda Tangan

Jam : Jam :

Cara pembayaran : Tagih Tujuan Tagih pada pengirim Tunai