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Payment to supplier Application Form

Company PT Country Garden Real Estate Application Date YX_WJSP2017
14/09/2017 BIP NO
(公司名称) Indonesia (申请日期)(day/month/year) (bip审批流程) 08080364
Applicant Merry 082110157788

Budget department Sales & Marketing Expense department 区域营销管理部

(预算部门) (费用归集部门)

Account No 营销-6601014 Account Type 服务费

(费用代码) (费用类型)

□ Advance Payment without invoice(无发票预付款)

Payment Type:
(付款类型) □ Advance Payment with invoice(有发票预付款)
□ Payment with invoice(有发票付款)

Form of Payment □银行电汇T/T □支票Check □汇票Note □对冲Offset

□其它Others(请注明To Clarify)__________________________________

Payment Amount: Amount(大写金额):Fourty Two Million Rupiah
(金额) IDR(印尼盾):42,000,000



Description To achieve the company brand online promotion, we need to build the Indonesian regional official website, website
(付款原因) design work for the contract approval application

Website design and function optimization costs has been approved on April 22, the tender bargaining process has been
approved on May 16, due to changes in design requirements, there is additional fee application, the cost of
additional has been approved on June 8 , the cumulative Approximately Rp 42,728,000 (about RMB 21,500) for the
approved fee. The contract is based on the tender price and the cost on the contract, the amount of the contract is
Rp 42,000,000 (about RMB 21252.05).

Total pahse 1 Amount this phase Rp 42,000,000 (RMB 21252.05)

(总付款次数) (本次付款金额)

Payment stage This phase 1 Accumulated % after this 100%

(付款节奏) (本次付款阶段) (累计支付比例)

Percetage Accumulated amount after

(本次付款比例) this(累计支付金额)
Name(收款人): Estimate Invoice Claim
PT Doxadigital Indonesia
Account no.(账号): Date(Advance Payment
Bank name(银行): Use Only):
Bank Central Asia (预计获取票据日期,仅无票预付款使用)

Prepared By:

Accountant Checked

Finance Manger
Checked By:

CFO Checked By: