Formulir 2a PU

BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

NN041938 RS MITRA SEHAT MEDIKA RS MITRA SEHAT MEDIKA 05 2019

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP

Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) (Rp.)
1 16008334340 3514120103890002 M.205.052 AAN SYAIFUDDIN 01-03-1989 01-02-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
2 17019541188 3514114310960001 M.307.018 ADEK OKTA YUSRONI PUTRI 03-10-1996 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
3 18018350878 3575012005870004 M.205.090 ADI HIDAYATULLOH 20-05-1987 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
4 12001431878 3504150704870003 AGUNG PUJIYANTORO 07-04-1987 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
5 15041474246 3514110809910001 AGUS MUHAMMAD 08-09-1991 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
SIROJUDDIN
6 17014014223 3514126105910001 M.206.039 AINUR RIZQI KURNIAWATI 21-05-1991 01-03-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
7 17019541154 5171012201910002 M.202.025 AJID MUHAIMIN 22-01-1991 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
8 12001431720 3514122411900002 AKHMAD ZAINI 24-11-1990 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
9 17019541162 3514117107960002 M.307.021 ALMAR'ATU SHOLIKHA 31-07-1996 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
10 12001432082 3515051901870001 ANAS SOLICHUDDIN 19-01-1987 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
11 15041474279 1256222509860001 ANDI PUJIANTO 25-09-1986 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
12 12001432165 3507314408900001 ANIS INDAH MRABAWANI 04-08-1990 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
13 17019541204 3514116106970001 M.307.024 ANISATUL AFIFAH 21-06-1997 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
14 18037856475 3575020601910002 M.205.043 ARIF MAS HUDA 06-01-1991 01-05-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
15 12001432090 3508141411860003 ARIF WICAKSONO 14-11-1986 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
16 12001431704 3514111608830003 ASIM 16-08-1983 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
17 18072422225 3513186707980001 AULIA SAKINAH 27-07-1998 01-09-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
18 15041474188 3517075208950002 AYIK IMAS AGUSTI 12-08-1996 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
19 13040881826 3514114602910002 AYU BUDIANTI 06-02-1991 01-11-2013 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
20 18018350845 3514126404890001 M.205.093 AYU DWI RINAWATI 24-04-1989 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
21 18056479977 3514121209940003 AYU INDAH LESTARI 12-09-1994 01-07-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
22 17003566753 3514126903940004 NM.1200.016 CHORIDA ZULAILA 29-03-1994 01-01-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
23 16030467845 3578092907880001 CHRISTIAN TANAYA, DR 29-07-1988 01-07-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
24 17003566761 3514115003850004 M.206.048 CHRISTIN 10-03-1985 01-01-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
25 18018350928 3514146104940005 M.205.092 CICIK ERNAWATI 21-04-1994 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
26 15041474287 3514115410900001 CITRA INDRISWARI 14-10-1990 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
27 07N40072936 3514115402860004 DESY EDY SAPUTRI 14-02-1986 01-05-2007 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
28 15041474212 3515055904900003 DEVI WITDYARTIH 19-04-1990 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
29 12001432108 3514125609880001 DEWI ANUGERAH PUTRI 16-09-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
WULANDARI
30 15041474154 3514112203910001 DIMAS WAHYU 22-03-1991 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
ARIESETYANTOKO
31 18018350795 3573011310820003 DWI KESUMAWANTO 13-10-1982 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
SAHIYUS
32 18018350902 3515047107940001 M.205.091 DWI LINDAH SANTI 31-07-1994 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

NN041938 RS MITRA SEHAT MEDIKA RS MITRA SEHAT MEDIKA 05 2019

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP

Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) (Rp.)
33 18018350894 3515084506860005 M.488.018 DWI NATULANI 05-06-1986 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
34 14011944809 3505036506850003 DWI YENIS 25-06-1985 01-04-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
35 12001431738 3515130509690001 EFFERSON WAROKKA 05-09-1969 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
36 14011944817 3524140502870001 EIKA DIDIT 05-02-1987 01-04-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
TAUFIQURROHMAN
37 12001431944 3514114304880002 EKA MUJIATI 03-04-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
38 15041474204 3514116403910002 ELLEN AYU OLGADIANA 24-03-1991 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
39 15041474220 3515046410880002 ENY KURNIAWATI 24-10-1988 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
40 16008334290 3515087011870004 M.206.045 ERNI TRI KURNIA 30-11-1987 01-02-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
HANDAYANI
41 12007026524 3514103101880001 FAIZAL AMIR [Link] 31-01-1988 01-03-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
42 12018887104 3514142302890001 FAKHRUDIN RIZKY 23-02-1989 01-06-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
43 12007026573 3507314909920002 FARIDATUL ISLAMIYAH 09-09-1992 01-03-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
44 17014014199 3514102705890004 M.202.018 FARIES RISZKI 27-05-1989 01-03-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
45 12007026482 3514096309890002 FAUZIA RUFAIDAH 23-09-1989 01-03-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
46 17072026341 3514094110920004 FIRDAUSI NUZULA 01-10-1992 01-12-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
47 16052387939 3514125307870001 M.205.071 GARNIS DWI HARTANINGSIH 13-07-1987 01-11-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
48 12001432231 3514116509880001 HELGA ERIKA SEPTIANA 25-09-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
49 17008601696 3514116102900004 M.205.030 HETIK FATMALASARI 21-02-1990 01-02-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
50 12043273213 3522080612880001 ICUK HARIANTO 06-12-1988 01-12-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
51 12001431837 3514095611740003 IIS SUSILOWATI 16-11-1974 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
52 16008334316 3514095305890001 M.205.073 INDAH KURNIATI 13-05-1989 01-02-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
53 18018350951 3514106712810001 INDRAWATI 27-12-1981 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
54 12001431845 3517024511850001 INEKE NOVILIA HARTONO 05-11-1985 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
55 18018350829 3514114609920001 M.205.069 INTAN PUSPITA SARI 06-09-1992 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
56 18064274030 3578252507840001 IQBAL SAYYIDIL AFFAN 25-07-1984 01-08-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
PURBA
57 14011944833 3514101909860001 JUWARI AJID BOY 15-09-1986 01-04-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
58 17019541196 3514114603970002 M.307.019 KARINA IMBAS SETIANTI 06-03-1997 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
59 14011944825 3514102307840006 KHOIRUL ANAM 23-07-1984 01-04-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
60 13011336289 3507256801930002 KUSTINI 28-01-1993 01-03-2013 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
61 18056479951 3514136310890001 LAILATUL MAULIDAH 23-10-1989 01-07-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
62 12001431977 3514135408860001 LILLA AGUSTINA 14-08-1986 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
63 18056479936 3514126908980001 LOLITA INDRIANI PUTRI 29-08-1998 01-07-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
64 17014014215 3514073001890002 M.202.012 M. LUKMAN JOYO 28-02-1989 01-03-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

NN041938 RS MITRA SEHAT MEDIKA RS MITRA SEHAT MEDIKA 05 2019

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP

Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) (Rp.)
65 18072422233 3514100112860001 M. MUNIF 01-12-1986 01-09-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
66 12001431787 3172052606610003 MACHFUD 26-06-1961 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 0.00 0.00 240,958.72
67 12001431670 3515131011720006 MANAGU GULTOM 10-11-1972 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
68 12001432041 3514115501900001 MARIA INDRIANI 15-01-1990 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
69 12001431696 3514115509740003 MARTINA DOLOK SARIBU 15-09-1974 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
70 14011944841 3514115806800003 MASRUROH 18-06-1980 01-04-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
71 12038276643 3514115205900004 MEIRINA DWI ANGGRAENI 12-05-1990 01-10-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
72 17025683362 3514111102920001 MOCHAMAD ERVIYANTO 11-02-1992 01-06-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
73 17019541212 3514110912910001 NM.1202.0036 MOCHAMMAD ROZIKIN 09-12-1991 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
74 15007330853 3514132003930002 MOCHAMMAD SONY PUTRA 20-03-1993 01-02-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
PRATAMA
75 18018350803 3578120408800004 M.205.054 MOHAMMAD FATIKUS 04-08-1980 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
SHOLEH
76 17019541170 3514111903940001 MOKHAMAD NURHADI 19-03-1994 01-12-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
77 18064274006 3514111412920001 MUCHAMAD SONHAJI 14-12-1992 01-08-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
78 14021037354 3514141501920001 MUHAMMAD IRFAN 15-01-1992 01-06-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
FIRMANDA
79 16016960862 3514112508840001 M.210.001 MUHAMMAD SAMPURNO 25-08-1984 01-04-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
80 15041474261 3516070809880002 MUSLIM BAKRI 08-09-1988 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
81 12001432314 3514135506880001 NAILUL FAUZAH 15-06-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
82 17025683370 3502190501930001 NANANG SETIABUDI 05-01-1993 01-06-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
83 18018350852 3514105407870001 M.206.031 NIAN SYAHRIA 14-07-1987 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
84 17019541139 3506087007970001 M.307.020 NIBEB ULY ARIFIASTUTI 30-07-1997 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
85 13033772206 2102074512860001 NM.1202.0026 NORA VERY 05-12-1986 01-10-2013 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
86 16008334266 5204255011880002 M.205.074 NUR AINI 10-11-1988 01-02-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
87 12001431811 3515065408830003 NUR KUSMIATININGSIH 14-08-1983 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
88 18080695275 3514125004930003 NUR QOMARIYAH 10-04-1993 01-10-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
89 18056479985 3514124309980005 NURIL ISNAINI 03-09-1998 01-07-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
90 13011336271 3514115004870001 NURUL HIDAYATI 10-04-1987 01-03-2013 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
91 12001431746 3514151908770002 NURUL YAQIN 19-08-1977 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
92 13011336263 3514117010860002 NYAMILA 30-10-1986 01-03-2013 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
93 14041011157 3514115005960001 M.307.023 OKKY DEVI RATNASARI 10-05-1996 01-12-2014 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
94 15041474196 3514104411960002 PUPUT ANDRAYANI 04-11-1996 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
95 16012848681 3515062808890004 M.488.022 RACHMAD SANTOSO 28-08-1989 01-03-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
96 12001431928 3514126403810003 RAHMAWATI SRI UTAMI 24-03-1981 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

NN041938 RS MITRA SEHAT MEDIKA RS MITRA SEHAT MEDIKA 05 2019

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP

Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) (Rp.)
97 12001432215 3516085108880003 RATNA WINARTI 11-08-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
98 12001431688 3515134909710006 REDI ULY PAKPAHAN 09-09-1971 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
99 12001432025 3514116202870001 REKHA PERYANNA 22-02-1987 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
100 11032606888 3514116404910004 RENI SILASTUTIK 24-04-1991 01-10-2011 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
101 16030467860 3515081612910002 RICO IRLANDIE M. 16-12-1991 01-07-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
102 17072026333 3514115107920002 RIDHO YULFIAH 11-07-1992 01-12-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
103 18018350936 3514104703890001 M.203.001 RINI KUSTINI 07-03-1989 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
104 12043273148 6409042509900003 RIO SEPTYAN SUSANTO 25-09-1990 01-12-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
105 16008334332 3514146210930002 NM.1009.004 RISTIAN FIRDAYANI 22-10-1993 01-02-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
106 16052387947 3514116012890003 NM.1300.008 ROBIATUL ADAWIYAH 20-12-1989 01-11-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
107 11000631165 3514096906870002 M.206.041 RUBI YUNITA SARI 29-06-1987 01-01-2011 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
108 12001431712 3514110504790002 RUDI SUGIANTO 05-04-1979 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
109 12001431753 3514150405920002 SAFIUDDIN 04-05-1992 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
110 17019541147 3514130601730003 NM. 1300. 003 SAMSUL 06-01-1973 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
111 17019541121 3573026406970001 M.307.022 SETYA ADEVIKA 24-06-1997 01-04-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
112 12001431860 3573024904820001 SILVIANA 09-04-1982 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
113 12001432116 3515024101890010 SINTA ROYANA 01-01-1989 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
114 18018350910 3515045509920004 M.213.004 SITI MURNI 15-09-1992 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
115 17014014207 3515046905880004 M.205.047 SITI NAHRIATI 29-05-1988 01-03-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
116 12001432124 3515046503840002 SITI ZUBAIDAH 25-03-1984 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
117 18056479944 3514086709950002 SRI WULANDARI 27-09-1995 01-07-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
118 12001431795 3514111609730001 SUGIANTO 16-09-1973 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
119 12001432306 3514122601810001 SUGIONO 26-01-1981 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
120 12001431779 3514121610700001 SUPARDI 16-10-1970 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
121 12001431761 3515041204790006 SUWANDI 12-04-1979 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
122 18018350837 3514130808840006 M.205.083 SYAIFUDIN ZUHRI 08-08-1984 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
123 18064274022 3578091310670001 TAN FRANKY TANDAYU 13-10-1967 01-08-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
124 18056479969 3514132005920001 TAUFIK CHUROHMAN 20-05-1992 01-07-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
125 12040419082 3514110710890002 TEGUH SANTOSO 07-10-1989 01-12-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
126 12007026540 3514100406710001 TISANO 04-06-1971 01-03-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
127 15041474162 3508080212930005 TRI DEVI PRIBADI 02-12-1993 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
128 12001431654 3514111203700007 TRI SUWAGIYANA 12-03-1970 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

NN041938 RS MITRA SEHAT MEDIKA RS MITRA SEHAT MEDIKA 05 2019

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP

Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) Pemberi Kerja (Rp.) Tenaga Kerja (Rp.) (Rp.)
129 11028941026 3514096309900002 TUTIK AGUSTINAH 23-09-1990 01-10-2011 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
130 17008601688 3514096506920001 M.205.041 VENNY WULANDARI 25-06-1992 01-02-2017 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
131 12001432207 3573014805880007 VITRI ASTUTIK 08-05-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
132 16008334274 3512072606870001 M.205.072 WAHYU KANDRA PINANDITA 26-06-1987 01-02-2016 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
133 12001431886 3525150610730002 WAHYUDI KURNIA 06-10-1973 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
134 18018350811 3514090808800004 NM.1200.020 WAWAN ROHMATULLOH 26-08-1982 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
135 12001431985 3514104509880004 WILIS ROKHMAWATI 05-09-1988 01-01-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
136 15041474170 3514105003960004 WIWIN ARISANTI 10-03-1996 01-08-2015 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
137 11024972819 3575025902880001 YENI WIDYA LESTARI 19-02-1988 01-08-2011 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
138 18018350886 3519114310910001 M.488.023 YULIANI 03-10-1991 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
139 18018350944 3514136606930001 M.488.017 YUNIAR EKA LANGEN SARI 26-06-1993 01-03-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
140 18029684133 5301062112930001 YUNIAS ROBINSON KANA 21-12-1993 01-04-2018 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26
141 12043273163 3514126104890003 ZULINAR NURSITA 21-04-1989 01-12-2012 3,861,518.00 0.00 9,267.64 11,584.55 142,876.17 77,230.36 77,230.36 38,615.18 356,804.26

Jumlah Seluruhnya 544,474,038.00 0.00 1,306,737.00 1,633,421.00 20,145,539.00 10,889,480.00 10,812,250.00 5,406,125.00 50,193,552.00

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