Shipment Details: 2 3 1 8 6 0 1 5 1 5 Inbound Charges Invoice

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PT.

BIROTIKA SEMESTA
Building F, Mulia Business Park
Jl. M.T. Haryono Kav 58-60
Jakarta 12780, Indonesia *2318601515*
Toll Free: 0-800-1333-333
NPWP 01.310.774.3-062.000
INBOUND CHARGES INVOICE
NAMA ARIK NURSAMSI D/A PANTI
Account Number : DUTYIDSUB
ASUHAN AMANAH HATI, DUKUH SUMPEL RT
KEC. JAMBON, KAB. PONOROGO, JAWA TI Invoice Number : D05734769
INDONESIA HWB Number : 2318601515
Date : 27/12/2020
Attn: NAMA ARIK NURSAMSI D/A PANTI
Contact Number: 62085332136216 Payment Due Date : 27/12/2020

Please Reimburse the Total Charges Shown Below To: PT. BIROTIKA SEMESTA

Shipment Details
Origin: SGN Pieces: 1 Contents: COAT
Destination: SUB Weight: 0.80 Assessed Value: Arrival Date: 26/12/2020

Billing Details
IMPORT EXPORT DUTIES 84,000
ADMINISTRATION FEES 50,000
DUTY HANDLING CHARGES (ADVANCE PAYMENTS) 100,000
VAT FOR OTHER CHARGES 15,000

Payment Terms
Cash on delivery unless
stated otherwise on the invoice
THIS IS A COMPUTER GENERATED INVOICE. NO SIGNATURE IS REQUIRED.
Please Pay This Amount: IDR 249,000

Remittance Advice

Company Signature / Stamp: Account Number : DUTYIDSUB


We enclose cash for IDR 249,000
Invoice Number : D05734769
We transfer using ADC link for IDR 249,000
HWB Number : 2318601515
We transfer to Virtual Account No.: 78902318601515
Date : 27/12/2020
Bank Name: CITIBANK INDONESIA
Total Amount IDR : 249,000
Bank Code: 0310305
Bank Account Name: PT BIROTIKA SEMESTA
Not all payment options are available to all countries

* 2 4 9 0 0 0 * * D U T Y I D S U B * * D 0 5 7 3 4 7 6 9 *

1. Detach this payment advice and return it together with your payment
2. Cheque should be crossed and made payable to PT. BIROTIKA SEMESTA

Customer Endorsement
SSPCP PIB/PIBT Nota 2A

We acknowledge receipt of the above documentation Account Number : DUTYIDSUB

NAMA ARIK NURSAMSI D/A PANTI Invoice Number : D05734769

Company Signature / Stamp: HWB Number : 2318601515

Printed Name / Title: Date : 27/12/2020

Total Amount IDR : 249,000

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