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Payment to supplier Application Form

对公费用申请单
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
(申请人)

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


(付款方式)
□其它Others(请注明To Clarify)__________________________________

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

为实现公司及项目品牌线上推广,需建设印尼区域官方网站,本次就网站设计工作进行合同审批申请

其中网站设计及功能优化费用4月22日已审批,招标议价流程5月16日已审批,定标Doxa
digital公司,因设计要求变更,增补附加费用申请,费用增补6月8日已审批,累计审批费用印尼盾42,728,000(约人民币21,500元
),本次合同根据招标议价及费用增补结果,合同金额为印尼盾42,000,000(约人民币21252.05元)。

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


100%
(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
5920300423
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:
(经办人签字)

Accountant Checked
By:
(会计审核签字)

Finance Manger
Checked By:
(财务经理审核签字)

CFO Checked By:


(财务总监审核签字)