Formulir 2a PU

BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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 21038232068 6404010308740001 ABDUL JALIL 03-08-1974 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
2 21038232563 6404012208900001 ABDUL KODIR 22-08-1990 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
3 21038233579 6404010101860002 ABDUL RAHMAN 01-01-1986 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
4 21038232050 6404050210720002 ABDUL RAUF 02-10-1972 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
5 21038233470 7307030210850002 ABDULLAH 02-10-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
6 23097395836 640409260298000219980226.471.00 ABDURRAHMAN 26-02-1998 01-01-2023 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
7 23097395760 640403470996000219960907.489.00 ADE KARTINI PUTRI 07-09-1996 01-01-2023 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
8 23160569747 6404051407040006 AFRIZAL 14-07-2004 01-10-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
9 21038232829 6404051708890004 AGUS KIBRAKA 17-08-1989 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
10 21038234460 6404053008880003 AGUS PRANS TINGANG 30-08-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
11 21038233421 6404051203940004 AGUS RAMADAN 12-03-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
12 21038233520 6404030404920002 AGUS RIYANTO 04-04-1992 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
13 23097395893 640405590804000120030819.505.00 AGUSRENTIANI ENNITA 19-08-2003 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
14 21038231938 6404014608960003 AGUSTINA 06-08-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
15 24124730375 640409570899000319990817555002 AGUSTINA 17-08-1999 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
16 21038233033 6404056508850003 AGUSTINA RANTETASAK 25-08-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
17 21038233025 6404050508780002 AGUSTINUS MOWENDU 05-08-1978 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
18 21038234247 6404052505870002 AHMAD ARAFAH 25-05-1985 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
19 23183171489 640407230105000120050123.529.00 AHMAD FARHAN 23-01-2005 01-11-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
20 21038231912 6404011311920003 AHMAD MAULANA 13-11-1992 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
21 21038232266 6404053007780004 AHMAD TRIYULIADI 30-07-1978 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
22 21038233876 6404055005880002 AJI AYUNITA KRISTININGRUM 10-05-1988 01-06-2021 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
23 23097396222 640401201099000119991010.441.00 AJI PRAMANA 10-10-1999 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
24 23097395901 6404015410000001 ALFA OKDRIANI 14-10-2000 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
25 21038233595 6404056404860002 ALFINA 24-04-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
26 21038232118 9109015504920002 ALFRIDA NANI YUSUF IPONG 15-04-1992 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
27 21038232282 6404050112730002 ALIMUDDIN 01-12-1973 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
28 21038234239 6404052204740002 ALPIN 22-04-1974 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
29 21038232605 6404012812960002 ANANDA RISQI 28-12-1996 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
30 21038234478 6404054303860008 ANDI RAHMAWATI MUNAWIR 03-03-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
31 23097395844 640411290402000220020429.492.00 ANDIN FAHRUL ALAM 29-04-2002 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
32 21038234395 1807110407930002 ANGGA MUHROM TOHANI 04-07-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
33 24059939413 640405550901000120010915555002 ANGGIA LARASATI 15-09-2001 01-03-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
AYUNINGTIAS
34 21038234452 6404056405910003 ANIS FATIHA 24-05-1991 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
35 23097395778 640405700897000219970830.452.00 ANISA 30-08-1997 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
36 24043531078 647302410997000619970901529002 ANNISA AMALLIA 01-09-1997 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
37 21038231607 6404054407920002 ANNISA DWI ASTRINI PUTRI 04-07-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
38 23097395786 640405610294000319940221.472.00 ARDIAN PEBRIANI REMPE 21-02-1994 01-01-2023 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
39 24043531276 640406160198000119980116529001 ARDIANSA PUTRA 16-01-1998 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
40 21038231995 6404050602820005 ARFAN 06-02-1982 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
41 21038231847 6404055206800008 ARI YUNITA 12-06-1980 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
42 21038232571 6404071512920001 ARIF SAGITA 15-12-1992 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
43 23097396297 640405051292000319921205.515.00 ARIPIN 05-12-1992 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
44 21038231474 6404051804790002 ARIS SUYONO 18-04-1979 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
45 23097396230 160310050596000319960505.511.00 ARMAN 05-05-1996 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
46 21038230872 6404055410940001 ARNI OKTASARI PUTRI 14-10-1994 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
47 21038232845 7317212204880001 ASMAUL 22-04-1988 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
48 21038232761 6404056810810001 ASMAWATI 28-10-1981 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
49 21038231250 6473017108940012 ASMERI 31-08-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
50 23097395919 7371140405840019 ASPIAN MIRSAH 04-05-1984 01-01-2023 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
51 21038233637 6404055411970002 AULIA DWI ROSSANA 14-11-1997 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
52 24059939322 640405421001000420011002555002 AURELIA RIZKI ANANDA 02-10-2001 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
53 21038233744 6404010704990002 BAHARUDDIN 07-04-1999 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
54 21038233124 6404010806940001 BAMBANG HARLEYANTO 08-06-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
55 21038230617 6405025807940003 BERTIANA SIMA 18-07-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
56 21038232126 3522180802920003 BOGI ADI UTOMO 08-02-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
57 23097395935 6404085402010001 BRIGIDA FEBRINI USUN 14-02-2001 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
58 21038233728 7318344512900002 CHRISTINA PALAYUKAN 05-12-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
59 21038230609 6404052412920001 CRISMAN PARRO 24-12-1992 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
60 23097395950 6404032006010001 CRISTOPER 20-06-2001 01-01-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
61 21038232274 6473016605890004 DAHLIA 26-05-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
62 23143269860 640405280587000119870528.524.00 DARMANSYAH 28-05-1987 01-09-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
63 23097395943 6404072812970001 DARWIN 28-12-1997 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
64 21038232043 6404012011000002 DATU ABDUL KHAIR 20-11-2000 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
65 21038233645 1207050609890002 DAVID M C PAKPAHAN 06-09-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
66 21038232159 6472066411910002 DEA SUSANTI 24-11-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
67 23097396255 640401280201000120010228.507.00 DEBBY FITRAH RIZALDY 28-02-2001 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
68 21038230856 6404055511000002 DEDE NOFRIANY 15-11-2000 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
69 21038232027 3509272411840004 DEDY HENDRY KURNIAWAN 24-11-1984 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
70 21038231805 3529122612790003 DEDY KURNIAWAN 26-12-1979 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
71 21038233546 6404062907980002 DENI NUR ADAM 29-07-1998 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
72 21038231888 7318114512890001 DEPRIANTI 05-12-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
73 23143269886 640401471298000119981207.522.00 DESI NURSAWATI 07-12-1998 01-09-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
74 21038231722 6404055112750003 DESI TODING 11-12-1975 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
75 21038232035 6404057012970004 DESY RAHMADANIAH 30-12-1997 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
76 21038232415 6404054503890001 DEVI MARSCELINA 05-03-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
77 24059939173 640404621200000120001222555002 DEVI NATALIA 22-12-2000 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
78 23097395752 640405640694000319940624.462.00 DEWI KUSUMASTUTI 24-06-1994 01-01-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
79 21038231169 6407056504870001 DEWI MAYASARI 25-04-1987 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
80 21038232167 6404016204910003 DEWI RATNA SARI 22-04-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
81 24124730458 640304540393000119930314555002 DEWI VANDRIANI 14-03-1993 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
82 24059939454 640401620501000120010522555002 DEWI WIDYA WARDANI 22-05-2001 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
83 23123227722 187101630287000419870223.520.00 DEWI WULANDARI,AMD.KEP 23-02-1987 01-08-2023 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
84 23097395968 6404052403020005 DIAN ACHMAD SURA 24-03-2002 01-01-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
85 21038232175 6473025905900003 DIAN DWI KESUMAWATI 19-05-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
86 21038232365 6404054102950005 DIAN NOVITASARI 01-02-1995 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
87 21038232373 6404056202910001 DIANA 22-02-1991 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
88 21038234155 6404056707870010 DIANA LESTARI 27-07-1987 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
89 21038234387 7317115212900007 DIANCRISTY PATANDIANAN 12-12-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
90 23097395976 6473012603980003 DIO HARTANTYO 26-03-1998 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
91 21038230666 6404051601940001 DONNY AGAPE ARIS 16-01-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
SUBIANTO
92 24043531185 641001220300000120000323529001 DT. ARIF RAHMAN BESTARI 22-03-2000 01-02-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
93 21038234148 6404054809900004 DWI UTARI 08-09-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
94 23097396032 6404035402950003 DWIYANTI MARLINA 14-02-1995 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
95 21038232407 6405024302920003 EDLIN ANDREAS 03-02-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
96 23097396008 6404012106960001 EDWAR HOPPER 21-06-1996 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
97 21038233868 3510090811900004 EDWIN TEGUH RAHMANTO 08-11-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
98 21038233447 6404052010890003 EDY SUPIANI 20-10-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
99 24059939389 640403150788000119980715555001 EKA HARMAWAN 15-07-1988 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
100 21038233629 6404055203910002 EKA TANTRI ARIANI 12-03-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
101 21038233355 6473044608930002 ELYS FARIDA HANDABI 06-08-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
102 24059939348 640405660896000119960826566002 EMMA THERESIA URING 26-08-1996 01-03-2024 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
103 21038233348 7403145011880002 ENDANG 10-11-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
104 24124729658 640401630399000119990323555002 ENDANG MANTIANA 23-03-1999 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
105 21038231755 3374122508880001 ERI WIDIARKO 25-08-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
106 23097396040 6404055603970001 ERNI 16-03-1997 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
107 21038234445 6404057105840003 EVY ANDREAS, S. TR. KEP 31-05-1984 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
108 21038233991 6404057004940001 FACHRIZA BANSIR 30-04-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
109 21038234007 6404053110880001 FAIZAL AMIR AL' AMRIE 31-10-1988 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
110 21038230658 6404011108900003 FAIZAL ARIEF 11-08-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
111 21038231391 6404054812810001 FARIDAH 08-12-1981 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
112 24081481905 640405620696000319960622555002 FAUZIAH BAHAR 22-06-1996 01-05-2024 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
113 23097395992 6473011403980003 FELIX HENDRA 14-03-1998 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
114 23143269894 640405310191000319910131.525.00 FERI FERNANDES NONG NAY 31-01-1991 01-09-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
115 24059939447 640401080697000219970608555001 FERRY FIRMANSYAH 08-06-1997 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
116 23097396024 5319012709000003 FINSENSIUS TAGUNG 27-09-2000 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
117 21038234197 6404054302850001 FIRDA RAHMAYANTI 03-02-1985 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
118 23097395984 6402024902980002 FIRYUNDA AYU PUTRI 09-02-1998 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
119 21038234205 7324015504910002 FITRIAN LINDA PAILANG 14-05-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
120 23097396057 1116084405910003 FITRIANA 25-03-1991 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
121 23097396016 6404024103950001 FITRIANI WAY GELALANG 01-03-1995 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
122 23097396065 6404010101990004 FITRIO SAHDAN ANDRIANO 01-01-1999 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
123 21038231821 6404051006860009 FITRIYADI 10-06-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
124 24059939199 640602420697000119970702555002 FLA INA JUNIAR 02-06-1997 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
125 21038234163 6404052103900003 FRANS TANDI PANGA 21-03-1990 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
126 23097396206 6404010510030001 FREDY NANDA SAPUTRA 05-10-2003 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
127 21038234429 6404022802880001 FRENSON DING 28-02-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
128 24043531102 352112661295000219951226529002 GIARNI 26-12-1995 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
129 21038233512 6404057108940001 GISELLA ADELIANI 31-08-1994 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
130 21038231698 6404050308900005 GUSTI 03-08-1990 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
131 21038233256 6404031511890002 HADI PURNOMO 15-11-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
132 23097396073 6404051009030001 HAFI ZULKODIM 10-09-2003 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
133 23097396115 6404051612040002 HAIRUL ANAM 16-12-2004 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
134 21038231839 6473035404910003 HALIFAH 14-04-1991 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
135 21038233017 6404015006900004 HALIPAH 10-06-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
136 23097395802 647301430194000919940103.465.00 HALWA NADIATINA LAILA 03-01-1994 01-01-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
137 21038233264 7315120608890001 HAMZAH 06-08-1989 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
138 21038233272 6404050602920003 HANAFIAH 06-02-1992 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
139 23097396081 6404011405850002 HANDRY YUDHISTIRA 14-05-1985 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
140 23097395810 727105501188000119881110.468.00 HANINA AL JUFRI 10-11-1988 01-01-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
141 21038234130 7314075911880005 HANNA NURDIN 19-11-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
142 21038230781 7371032209880004 HARDI 22-09-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
143 21038234080 6404055507980004 HARMIANI 15-07-1998 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
144 24059939397 640401590596000219960519555002 HARTINAH MUHARRAMAH 19-05-1996 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
145 21038233587 6402165507890002 HEDAR 15-07-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
146 21038230807 6404051811970001 HENDRIYANUS DENES 18-11-1997 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
147 21038233066 6404082102880001 HENGKI IFUNG 21-02-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
148 21038231904 6404010807000001 HENGKY GILANG FIRNANDO 08-07-2000 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
149 21038230914 6404050509930003 HERNIN KALAGAN 05-09-1993 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
150 21038233819 6404012208820004 HERPAN 22-08-1982 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
151 21038230930 6404053105850001 HERU TRI CAHYONO 31-05-1985 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
152 23097396156 6473023101910005 HERY TRIADI 31-01-1991 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
153 21038234411 6404055112850005 HERYANI 11-12-1985 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
154 21038233793 6404055209850004 HESTI PURWATI 12-09-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
155 23097396214 6473016412970005 HESTIWINATA WILLIAM 24-12-1997 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
156 21038234213 6404055802900004 HIKMAH JUFRIE 18-02-1990 01-06-2021 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
157 21038230732 6405030704810001 HOTMAN 07-04-1981 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
158 23097395828 640405470996000119960907.461.00 ICHA CLOUDIA CRISHTIN 07-09-1996 01-01-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
159 24043531110 640405450497000219970405529002 IKA APRIYANTI ARUM PUTRI 05-04-1997 01-02-2024 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
160 21038231516 6404055501930005 IKVA JUNIARTI 15-01-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
161 21038232506 6404010106810006 ILHAM 01-06-1981 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
162 21038233215 6404052611900005 IMAM KHUDLORY 26-11-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
163 21038231060 7310040210910001 INCE KARIM ISMAIL 02-10-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
164 21038233710 6404055209890002 INDAH PURNAMA SARI 12-09-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
165 21038233785 6404052402880001 INDRA LESMANA 24-02-1988 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
166 23097395794 640602561295000119951216.499.00 INDRIANI DWI ASTUTI 16-12-1995 01-01-2023 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
167 24043531193 640405450201000320010205529002 IRMA RIZKY AR 05-02-2001 01-02-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
168 21038233850 6404055006850003 IRMAYANTI 10-06-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
169 21038234031 6404011303790002 ISKANDAR 13-03-1979 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
170 23097395885 640405500396000219960310.498.00 ISMARIYAH 10-03-1996 01-01-2023 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
171 21038233082 6404056106930005 ISTASARI SUHANDA 21-06-1993 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
172 21038232894 6404054203830005 ITA DWI NUR KHASANAH 02-03-1983 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
173 21038232860 6404055709970001 JESSY DWINADA 17-09-1997 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
174 21038232480 6404051111000001 JOKO LELONO 11-11-2000 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
175 21038233330 6404041305950004 JONESANTONIUS 13-05-1995 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
176 21038233207 6473041206880001 JONI PRASTIONO ARUNG 12-06-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
PAEMBONAN
177 21038232647 6404010911960002 JONI SETIAWAN 09-11-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
178 21038232258 6404051612880003 JOSNATA LAYUK 16-12-1988 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
179 21038233371 1212010501960002 JOSUA TAMBUNAN 05-01-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
180 24124730409 640515450295000119950723555002 JULIANTI 23-07-1995 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
181 23097395927 731716521283000319831212.478.00 JUMARTI 12-12-1983 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
182 21038234361 7371095206850006 JUMRAH PAKULUH 12-06-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
183 21038234320 6111025505710002 JUMRAWATI 15-05-1971 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
184 23097396263 6404054403900002 JUMRIATI SENGA' 04-03-1990 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
185 21038233454 7310104706920001 JUNARTI TANDI RERUNG 07-06-1992 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
186 21038233843 7316054306830002 JUSTINA 03-06-1983 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
187 21038234023 6404056611800001 KARMILA NOPRIANI 26-11-1980 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
188 24059939371 647301571000000820001017555002 KARTIKA 17-10-2000 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
189 23160569739 640405200696000319960620.527.00 KEVIN ARIEL TIOPAN 20-06-1996 01-10-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
SIMANJUNTAK
190 21038232225 6404044101830005 KRISTIANI RIN 01-01-1983 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
191 21038230963 6404040606910003 KRISTIONO SUTRA JUNIANTO 06-06-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
192 23097396271 6404051307840004 KURDY RIMBAWANSYAH 13-07-1984 01-01-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
193 21038233405 6408086708930001 LAAN SAMUEL 27-08-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
194 21038232233 6404025708640001 LAURENSIA J 17-08-1964 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
195 23097395661 640408520995000119950912.479.00 LINDA SEPRIANI 12-09-1995 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
196 23097396107 6404036804990002 LUSIANA DEWI 28-04-1999 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
197 21038231425 6404010502790002 M. YANTO 17-02-1979 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
198 23097396131 6404016505970002 MARDALENA 25-05-1997 01-01-2023 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
199 21038232357 6404055103900002 MARETTI NURAINY 11-03-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
200 21038232696 6404036003970001 MARGARETA 20-03-1997 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
201 24059939215 640405520102000220020112555002 MARIANA ARINI 12-01-2002 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
202 21038232001 7322025208820002 MARIATUN 12-08-1982 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
203 21038233934 6404056403850001 MARINI LESTARI 24-03-1985 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
204 21038232720 6404056005920002 MARISA 20-05-1992 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
205 21038232977 6404052812790001 MASHURI 28-12-1979 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
206 23160569713 6404055705020001 MAULIDA AULIA 17-05-2002 01-10-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
207 24059939363 640403670300000120000327555002 MELA AGRETA 27-03-2000 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
208 24059939314 640404230597000219970524555001 MELSONY 24-05-1997 01-03-2024 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
209 21038233926 6404024902930001 MERCYLINIA PRANCISKA 09-02-1993 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
210 24059939249 640503710398000119980331555002 MERSILENA 31-03-1998 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
211 21038233702 6404010405980002 MEYDI YOSSUA 04-05-1998 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
212 21038232886 6404015407860001 MIA MUZAIZANAH 14-07-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
213 24043531268 647205661296000419961226529002 MILDAWATI 26-12-1996 01-02-2024 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
214 21038230625 6404015006930003 MISBAH 10-06-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
215 24043531177 640405090591000219910509529001 MOCHAMMAD FAUZAN 09-05-1991 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
216 21038234338 6404011202010001 MOHAMMAD BAGUS 12-02-2001 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
FERDIANSYAH
217 21038233462 6404050305690005 MOKHAMAD FADIL 03-05-1969 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
218 23097396172 7313090508940002 MUH. EFENDI 07-03-2002 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
219 24043531284 647303050694000519940605529001 MUHAMAD HIRID 05-06-1994 01-02-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
220 21038232498 6404050609000001 MUHAMMAD AKBAR DARWIS 06-09-2000 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
221 23097396123 6404052410970002 MUHAMMAD ALDY YANSYAH 24-10-1997 01-01-2023 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
222 24043531029 640602020299000119990202529001 MUHAMMAD ALI 02-02-1999 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
223 21038233900 7308082311940001 MUHAMMAD ASWIN 23-11-1994 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
224 24059939223 640401050902000120020905555001 MUHAMMAD ASYARIE 05-09-2002 01-03-2024 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
225 6404011008040001 MUHAMMAD EKA GUSTI 10-08-2009 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
SETIAWAN
226 23097396180 6404011609910001 MUHAMMAD NUR R 16-09-1991 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
227 23097396149 6404012511960001 MUHAMMAD ZAKARIA 25-11-1994 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
228 21038234106 6404121309700001 MUKIAT 13-09-1970 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
229 21038231953 6404055011850001 MUSTIKASARI 10-11-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
230 21038234056 6404056904970004 NABILAH AFIFAH AHMADI 29-04-1997 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
231 24059939207 640405120698000219980612555001 NASRI 12-06-1998 01-03-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
232 23097395711 731409410795013519950422.475.00 NASRIAH 22-04-1995 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
233 21038233116 6404011611820003 NASRULLAH 16-11-1982 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
234 21038232746 6404010212940001 NEGAR DHARMAWAN 02-12-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
PRATAMA
235 23097395679 640405521092000319960907.490.00 NI LUH PUTU WULANSARI 12-10-1992 01-01-2023 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
236 21038231375 6473014410900002 NIKMASARI 04-10-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
237 21038232803 6404055404850003 NIRMALA SARI 14-04-1985 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
238 21038232621 6404050111880001 NONJI NOER FIANSYAH 01-11-1988 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
239 21038232944 6404084512900002 NORVINA 05-12-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
240 21038232811 6404056809910002 NOUR JANAH 28-09-1991 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
241 21038232688 9102014901920003 NOVALIA 09-01-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
242 21038232738 7317215010940005 NOVIANTY PATINARAN 10-11-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
243 21038232597 6404026311950002 NOVITA 23-11-1995 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
244 21038230708 6404015911940001 NOVITASARI 19-11-1994 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
245 21038231201 6404014905900002 NUR AIKA 05-09-1990 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
246 21038232704 6404014609930002 NUR AKTIFA 06-09-1993 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
247 23097396164 6404012004990003 NUR ALAM SYAH 20-04-1999 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
248 24059939231 640401531000000220001013555002 NUR ANISA 13-10-2000 01-03-2024 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
249 24059939256 640405690902000320020929555002 NUR ANNISA MAHARANI 29-09-2002 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
250 24059939298 640405521102000220021112555002 NUR ASRIKA ASIKIN 12-11-2002 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
251 24059939181 640405610701000221072001555002 NUR FADILLAH PUTRI 21-07-2001 01-03-2024 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
252 24124730425 640401561095000319951016555002 NUR FITRIA EKA ASTUTI 16-10-1995 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
253 21038233538 6403054511960003 NUR ISTIQOMAH 05-11-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
254 24141472738 647301520305000220050312594002 NUR MARCHAYANI BT AHMAT 12-03-2005 01-09-2024 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
255 21038230898 6404057012920003 NUR MAYANG SARI 30-12-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
256 24043531219 640405420294000219940202529002 NUR RAHMANI 02-02-1994 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
257 21038233074 6473026112940005 NUR RAHMI PAJRIA 21-12-1994 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
258 21038231649 6404055712980002 NURIFFAH HANDAYANI 17-12-1998 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
259 21038234312 6404051911870002 NURSAN 19-09-1987 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
260 23097396321 7315051303940002 NURSYAWAL 13-03-1994 01-01-2023 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
261 24043531169 640412500402000420020410529002 NURUL SAFIRA ALIKA 10-04-2002 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
262 23097395596 6404010911030001 NUZUL RAMADHANI RIZKI 09-11-2003 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
NAZAR
263 24059939280 640401010296000119960201555001 PAISAL RAMADHAN 01-02-1996 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
264 21038231854 6473041410890001 PARDANI HABIBI 14-10-1989 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
KARTASASMITA
265 21038234296 6474013105900004 PARYANTO 01-05-1990 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
266 21038234353 6473024710860003 PAULIANA KANDA 07-10-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
267 21038233488 6404055909950003 PEGI SINTA 19-09-1995 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
268 21038234379 6404050307880003 PRAYUDI PALEBANGAN 03-07-1988 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
269 23097395851 640405110890000111081990.484.00 PRINGGO AHMAD EKO FAUZI 11-08-1990 01-01-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
270 21038233561 3375036807950005 PRISKY CHRISELAWATI 28-07-1995 01-06-2021 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
271 21038231946 6404051807930002 PUGUH RAHMADI 18-07-1993 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
272 23097395604 7315053112020034 PUTRA PRATAMA 31-12-2002 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
273 24043531201 647301620200000320000222529002 PUTRI 22-02-2000 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
274 24059939272 640405430402000420020403555002 PUTRI AFRIANI 03-04-2002 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
275 23097395729 731602540295000419950214.510.00 RABAYSA 14-02-1995 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
276 23097395570 6404056308920003 RADITYA ENDAH DINIASTUTI 23-08-1992 01-01-2023 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
277 24124730441 640405091001000420011009555001 RAFLI ERVAN HIDAYAT 09-10-2001 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
278 23097395612 6406024801990002 RAHMADANIA JAYANTI 08-01-1999 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
279 21038233835 6404050505960001 RAHMAN SYARIF 05-05-1996 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
280 24059939421 6404052011010001 RAMADHAN BAYU PRASETYA 30-11-2001 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
281 21038234114 6404010706940003 RANDI AGUNG SAPUTRO 07-06-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
282 21038234221 7306065009890002 RATIH DYATMIKO PUTRI 10-09-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
283 21038233413 7371144504900015 REGAR SRI UTAMI 05-04-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
284 24141472720 640405661003000120031026593002 RENA SAFHIRA 26-10-2003 01-09-2024 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
285 24043531235 640405460496000419960406529002 RESHA AYU VALENTINA 06-04-1996 01-02-2024 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
286 24059939405 640405510401000620010522555002 RESKY PUTRI 11-04-2001 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
287 21038230591 6404056710960001 RIBKA 27-10-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
288 21038231094 6404032510920002 RIKA HERIDAYANA 25-10-1992 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
289 21038231011 6404056901870002 RIKA MARLITASARI 29-01-1987 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
290 23097395562 6404050803910001 RINALDY ANDRIANSYAH 08-03-1991 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
291 24059939306 640402540699000319990614555002 RINAWATI 14-06-1999 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
292 21038231623 6404085501920002 RINAYANTI 15-01-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
293 21038233694 6404055707930002 RISA AYU JULITA 17-07-1993 01-06-2021 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
294 23097396289 6404046601000001 RISKA APRIANI 26-01-2000 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
295 21038233280 6404054411960001 RISKA AYU WIBAWENI 04-11-1996 01-06-2021 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
296 24059939330 640401420200000420000202555002 RISMALA EGITASARI 02-02-2000 01-03-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
297 21038230724 6404046107950002 RISMANITA YULI PURNAMA 21-07-1995 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
298 21038231276 7324076901900002 RISMAYANTI 29-01-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
299 24043531292 760209711294002519960626529002 RISNAWATI 26-06-1996 01-02-2024 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
300 24124729674 640502631097000119911023555002 RISNAWATI 23-10-1991 01-08-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
301 21038232613 6404014107940069 RITA 01-07-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
302 21038233611 6404052612910003 RIYAN JADI KUSUMA 26-12-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
303 21038232589 3509275009850005 ROFIKA SETYO RINI 10-09-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
304 21038232662 1102120302720001 RUSMAN 03-02-1972 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
305 21038232670 7316014410910001 RUSNI SANGKA 04-10-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
306 21038231789 6404056406910005 RUT YUNIELIS 24-06-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
307 21038230690 6404052610740002 SAFRUDIN HASAN 26-10-1974 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
308 23097395695 640401430297000219970203.463.00 SALMAH 03-02-1997 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
309 21038234072 6404056804910004 SALMIAH 28-04-1991 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
310 23097395745 640405660302000120020326.504.00 SALSABILA SEKAR TANJUNG 26-03-2002 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
311 24059939439 6404075703010002 SALSABYLA ASKY 17-03-2001 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
312 21038234270 6404055108780001 SANAWIAH 11-08-1978 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
313 21038232795 7316032805900001 SANDI PUTRA 28-05-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
314 23097396347 6404037006030001 SANTI KRISTIANI 30-06-2003 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
315 21038234304 7373064508860001 SARLIA 05-08-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
316 24043531243 640405570200000220000217529002 SARLY NUR MILLINIA 17-02-2000 01-02-2024 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
FEBRIANTI
317 21038232522 7306084502930012 SARTINA 05-02-1993 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
318 21038233058 6404010510850004 SAYID MUHAMMAD IDRIS 05-10-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
319 21038232209 6404054207960007 SEKAR ARUM 02-07-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
320 24043531151 640509410997000119970901529002 SELVIA SYAMSIAH SARI 01-09-1997 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
321 21038231342 6404056402830001 SENSUSWATY 24-02-1983 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
322 21038232969 6406114909920001 SEPTIANI 09-09-1992 01-06-2021 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
323 21038232464 6404055203960001 SITI FATIMAH 12-03-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
324 21038232548 6472026304950003 SITI FATIMAH 23-04-1995 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
325 21038232530 6404014107770072 SITI HUZAIMAH 01-07-1977 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
326 21038232456 6404054506900002 SITI MAISARA 05-06-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
327 23097395638 6406025809990001 SITI NURHADIJAH 18-09-1999 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
328 21038232332 6404054901920006 SITI NURZANAH 09-01-1992 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
329 21038230773 6404054910910003 SITI RACHMAH 09-10-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
330 21038233389 6404050911800004 SITIZEN 09-11-1980 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
331 23097396305 6404011407830001 SOLIKIN 14-07-1983 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
332 24043531227 630704450888000419880505554002 SRI HAYATI 05-05-1988 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
333 21038232134 6404046707900001 SRI MARLINA 27-07-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
334 21038233041 6404055801860001 SRI PURNOMO HANDAYANI 18-01-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
335 24059939264 647302620601000820010622555002 SRI WAHYUNI 22-06-2001 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
336 21038232076 6404050811820001 SUARMAN 08-11-1982 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
337 23097395620 6404011212930003 SUHERMANTO, A.MD.KEP 12-12-1993 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
338 24043531128 640401551100000120001115529002 SULASTRI 15-11-2000 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
339 24059939355 647301420602000320020702555002 SULFIAH 02-07-2002 01-03-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
340 21038232837 7204011212990001 SULKIFLI 12-12-1999 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
341 21038232084 6404055407730002 SUMIATI 14-07-1973 01-06-2021 2,200,000.00 0.00 5,280.00 6,600.00 0.00 0.00 0.00 0.00 0.00 0.00 11,880.00
342 21038232381 6404050703840004 SUNARDI RUDDIN 07-03-1984 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
343 23097396339 7372022712870002 SUPRIADI 27-12-1987 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
344 21038232399 6404016709900002 SUPRIHATIN 27-09-1990 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
345 23097396313 6404050606020004 SURYA MAULIDDIN 06-06-2002 01-01-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
NUR'ATSAR
346 24043531136 640405150196000119960115529001 SYAMSUDDIN 15-01-1996 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
347 21038232217 6404095807950001 SYARIFAH NOUR ZAQIYAH 18-07-1995 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
348 21038232092 6404032511890002 TARNO LISISKA 25-11-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
349 21038232308 6404051905850003 TAUFIK 19-05-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
350 21038232753 6404012404970001 TEGUH DARMANTO 14-04-1997 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
351 24043531250 737110660995000519950926529002 TENRI SANNA 26-09-1995 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
352 23097396248 352802431095000319951003.466.00 TIKA AYU SARASWATI 03-10-1995 01-01-2023 7,000,000.00 0.00 16,800.00 21,000.00 0.00 0.00 0.00 0.00 0.00 0.00 37,800.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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.)
353 21038232639 6404034101910006 TRI BARU ASIH 01-01-1991 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
354 21038233298 6404056911930001 TRI NOVITA SARI 29-11-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
355 21038233181 1201070803010001 TRY SULISTIYONO 28-03-2001 01-06-2021 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
356 21038233165 7317142909940001 TURISNO 29-09-1994 01-06-2021 3,500,000.00 0.00 8,400.00 10,500.00 0.00 0.00 0.00 0.00 0.00 0.00 18,900.00
357 24043531144 640405510401000320010411534002 ULFAH APRIYANI 11-04-2001 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
358 21038233223 6404015611870003 ULFAIJAH 16-11-1987 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
359 24043531060 640406451096000119961005529002 ULFATIMAH 05-10-1996 01-02-2024 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
360 21038232142 6404026101930001 VICTORIA JUARI 21-01-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
361 21038232472 6404052311910001 WAHYU PRASITIYO 23-11-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
362 23097396354 6404030206990003 WAHYU PUTRA PRATAMA 02-06-1999 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
363 21038232100 6404012803940001 WAHYUDI FIRMANSYAH 28-03-1994 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
364 21038233975 6404052708950004 WAHYUDIANI 27-08-1995 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
365 21038233140 6404055209930002 WAHYUNENGSIH 12-09-1993 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
366 21038233108 6404081912940001 WANDI ANDRIANTO 19-12-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
367 21038231037 7105096810850001 WENTI NURYANITA 28-10-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
368 24043531037 640405571297000319971227529002 WIDYANTHI NUR HIKMAH 17-12-1997 01-02-2024 4,500,000.00 0.00 10,800.00 13,500.00 0.00 0.00 0.00 0.00 0.00 0.00 24,300.00
369 21038231458 6404012109890001 WIRA AJI PRACOYO 21-09-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
370 21038232910 6404057101860001 WIRA SUANA PRIYATIN 31-01-1986 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
371 21038232779 6404014809940002 YENI HARSIANI EVITASARI 08-09-1994 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
372 21038233686 6403057010890001 YESI SIMBONG 30-10-1989 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
373 23097395646 7372022306960002 YOHANIS BABTISTA WAHYUDI 23-06-1996 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
374 21038230682 6404011910960001 YUDHY ANGGARA SAPUTRA 19-10-1996 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
AR
375 21038233959 6404025105960001 YULIANA 11-05-1996 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
376 23097395703 6404050911970005 YUMAS GALANG PRAKOSO 09-11-1997 01-01-2023 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
377 21038233652 6404055506910002 YUNI SERLIANI 15-06-1991 01-06-2021 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
378 23097395737 6404044909980002 YUNITA 09-09-1998 01-01-2023 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
379 21038232514 6404041005850002 YUPITER AJANG 10-05-1985 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
380 23097395687 6404037101950004 YUSTINA GRASELA 31-01-1995 01-01-2023 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
381 21038232316 1207227004910003 YUYUN AMELIA SIANIPAR 30-04-1991 01-06-2021 2,700,000.00 0.00 6,480.00 8,100.00 0.00 0.00 0.00 0.00 0.00 0.00 14,580.00
382 23143269878 731510510194000119940111.521.00 ZAHRA UMAR 11-01-1994 01-09-2023 2,800,000.00 0.00 6,720.00 8,400.00 0.00 0.00 0.00 0.00 0.00 0.00 15,120.00
383 21038233678 6404012812890002 ZAINUDDIN 28-12-1989 01-06-2021 2,500,000.00 0.00 6,000.00 7,500.00 0.00 0.00 0.00 0.00 0.00 0.00 13,500.00
384 23097395653 640401241000000120001024.456.00 ZAKARIA 24-10-2000 01-01-2023 2,600,000.00 0.00 6,240.00 7,800.00 0.00 0.00 0.00 0.00 0.00 0.00 14,040.00
 Formulir 2a PU
BPJS Ketenagakerjaan
RINCIAN IURAN TENAGA KERJA

NPP Nama Perusahaan Nama Unit Kerja Periode Laporan

21095448 BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN BLUD RSD DR. H. SOEMARNO SOSTROATMODJO - NON ASN 10 2024

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 1,104,300,000.00 0.00 2,650,320.00 3,312,900.00 0.00 0.00 0.00 0.00 0.00 0.00 5,963,220.00

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, 26 Oktober 2024

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