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Jl. Petogogan I No.16 Blok A Kebayoran Baru Jakarta 12140 INDONESIA T. +6221 7394126 F.

+6221 7255414

INVOICE
Invoice No #102-001/II-04011/BMA-02 Date April 18, 2011

BILL TO : SPICA SERVICES (INDONESIA) PT. SPICAPUTRA SARANA SETIA BUDI 2, 3A Floor, Suite 3A04 A Jl. H.R. Rasuna Said Kav.62 Jakarta 12920

Medical Advance - Lippo Village TANGERANG Mr. AVELINO TALIAO - PHILIPINE

1 USD = Rp8,500 CODE DESCRIPTION BMA - HT/04 - 2011/II : TR-SR/01 TR-SE/01 rm. A (TOTAL CHARGE ) 20,588.24 DEPOSIT Siloam Hospital Karawaci BANTEN MEDICAL ESCORT Siloam Hospital Karawaci BANTEN 80,000,000 95,000,000 9,411.76 11,176.47 UNIT PRICE LINE TOTAL

PAYMENT TRANSFER TO : PT. BINA ARTHA KREASINDO CIMB NIAGA Branch Fatmawati A/C . 917.02.01674.00.6 SWIFT CODE : BNIAIDJA

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