Formulir 2a PU

BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

XX004298 KLINIK DAN APOTEK KARYA PRIMA (02139) KLINIK DAN APOTEK KARYA PRIMA (02139) 07 2021

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP Iuran JKP
Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Pemberi Kerja Tenaga Kerja Pemberi Kerja Tenaga Kerja Pemberi Kerja Pemerintah Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.)
1 20091588663 5171046305920005 - A.A.BULAN GINITRI 05-11-1992 01-12-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
2 18031701826 5107045604920002 ADE INDAH PRATIWI 16-04-1992 01-05-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
3 18031701750 5171042405920004 ANDI WIRANATHA NUGRAHA 24-05-1992 01-05-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
4 20079882708 5271055112930001 - DEK PUETERI DEWI SURYANI 11-12-1993 01-11-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
5 09016149784 5106035511760001 DEWA AYU KETUT ANOM 15-11-1976 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
MULIAWATI
6 11039706301 5171024702680003 DR. LUH GEDE TRISNA ADI 07-02-1968 01-10-2011 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
7 18031701818 5171016009790009 DRG.PNIELLA MYDDIYANT 20-09-1979 01-05-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
8 09016149719 5171042110860001 DWI YANTO PRASETYO 21-10-1986 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
9 20091588671 5103026906930001 - I GUSTI AYU NITA 29-06-1993 01-12-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
AKSAMALIKA
10 09016149693 5107041004830006 I PUTU EDY MAS SETIAWAN 10-04-1983 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
11 20091588697 5171020202920002 - I PUTU GDE HENDRA 02-02-1992 01-12-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
SAPUTRA
12 20091588689 5171010605910008 - I WAYAN MERDIYANA EKA 06-05-1991 01-12-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
PUTRA
13 09016149727 5171010802720005 I WAYAN NESA ARSANA 08-02-1972 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
14 09016149743 5171025407810002 KADEK ARY ARTHAYANTI 14-07-1981 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
15 18089706966 5107046810920002 - LUH DEAYU KRISNA DEWI 28-10-1992 01-11-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
16 09016149677 5171035607800001 - MIA AYUSTINA PRASETYA 16-07-1980 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
17 20079882690 5171034906940001 - NI KETUT AYU SANJIWANI 09-06-1994 01-11-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
PUTRI
18 19077427375 5106046909920008 - NI KETUT MUDIARTINI 29-09-1992 01-10-2019 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
19 20091588655 5103016608920003 - NI LUH KRISNA AGUSTINI 26-08-1992 01-12-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
20 19060550985 5304124503900001 - NI LUH SRI ASTUTI 05-03-1990 01-08-2019 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
21 20079882674 5104055103940005 - NI LUH SRI HANDAYANI 11-03-1994 01-11-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
22 09016149776 5171017006780003 NI MADE ANIK YUNIAWATI 30-06-1978 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
23 18060244250 5104015912930001 - NI MADE GITA ANINDITA 19-12-1993 01-08-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
NIRMALA PUTRI
24 18031701800 5171014503830006 NI NYOMAN AYU SUTARNIATI 05-03-1983 01-05-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
25 20079882682 5171014205970002 - NI NYOMAN PUTRI 02-05-1997 01-11-2020 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
DAMAYANTI
26 18031701776 5102066706910001 NI NYOMAN YUNITA 27-06-1991 01-05-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
PURNAMI ASIH
27 18060244292 5104055510920001 - NI PUTU OKTARIANI 15-10-1992 01-08-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
28 09016149735 5104066308790001 NI PUTU YUDIASRI 23-08-1979 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
29 09016149768 5103026006780005 NI WAYAN RUSTIANI 20-06-1978 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
30 09016149750 5171034201670002 NYOMAN RATNA DEWI 02-01-1967 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
31 18031701792 5101015503890009 SHINTA AYU NANI 05-03-1989 01-05-2018 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
32 09016149685 5171014206700002 SUKATI 02-06-1970 01-09-2009 2,363,000.00 0.00 5,671.20 7,089.00 87,431.00 47,260.00 0.00 0.00 0.00 0.00 147,451.20
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

XX004298 KLINIK DAN APOTEK KARYA PRIMA (02139) KLINIK DAN APOTEK KARYA PRIMA (02139) 07 2021

No. Nomor Nomor Induk Nomor Tgl Iuran JHT TK Iuran JP Iuran JKP
Referensi Kependudukan Pegawai Nama Tenaga Kerja Tanggal Lahir Kepesertaan Jumlah Upah Jumlah Rapel Iuran Jkk Iuran JKM Pemberi Kerja Tenaga Kerja Pemberi Kerja Tenaga Kerja Pemberi Kerja Pemerintah Total Iuran
(NIK) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.) (Rp.)

Jumlah Seluruhnya 75,616,000.00 0.00 181,478.00 226,848.00 2,797,792.00 1,512,320.00 0.00 0.00 0.00 0.00 4,718,438.00

Keterangan
*) Isian formulir ini dapat disampaikan kepada BPJS Ketenagakerjaan dalam bentuk media elektronik (softcopy) ataupun hasil cetakan dari sistem
penggajian perusahaan peserta yang bersangkutan, dengan aturan / format yang sesuai dengan ketentuan BPJS Ketenagakerjaan

, 26 Juli 2021

(Nama dan Tanda Tangan Pimpinan Perusahaan)

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