LAPORAN TRANSAKSI FINANSIAL

STATEMENT OF FINANCIAL TRANSACTION

Halaman 1 dari 6
Page 1 of 6

Tanggal Laporan : 28/12/23

Kepada Yth. / To : Statement Date

JERI ATMANTO Periode Transaksi : 01/10/23 - 31/10/23

Transaction Periode

JL TELUK SEPINGGANMUARA SIRAN, MUARA

SIR,AN,KUTAI KARTANEGARA MUARA KAMAN
KUTAI KARTANEGARA

No. Rekening : 459901016255535 Unit Kerja : UNIT KOTA BANGUN TENGGARONG

Account No Business Unit

Nama Produk : SIMPEDES UMUM Alamat Unit Kerja : KANCA TENGGARONG

Product Name Business Unit Address KANWIL BANJARMASIN

Valuta : IDR
Currency

Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo

Transaction Date Transaction Description User ID Debit Credit Balance

01/10/23 09:01:48 NBMB JERI ATMANTO TO RISMAN RIPANDI 8888470 50,000.00 0.00 15,005,683.00
ESB:NBMB:0001500F:590623504432

01/10/23 09:10:57 BRIVA88810082353122213NBMBDNID RAHXXX 8888412 90,000.00 0.00 14,915,683.00

BRIVA 88810082353122213NBMBDNID RAHXXX
ESB:NBMB:0200200P:590627164986

01/10/23 19:03:32 BRIVA88810085348196022NBMBDNID MISXXX 8888027 1,000,000.00 0.00 13,915,683.00

BRIVA 88810085348196022NBMBDNID MISXXX
ESB:NBMB:0200200P:590867566488

01/10/23 23:59:59 082220297881|2SMS|27/09/2023-27/09/2023 DDY402 1,000.00 0.00 13,914,683.00

02/10/23 12:01:05 BRIVA88810085348241872NBMBDNID SURXXXXXX 8888143 500,000.00 0.00 13,414,683.00

BRIVA 88810085348241872NBMBDNID SURXXXXX
ESB:NBMB:0200200P:591150057506

02/10/23 12:30:52 NBMB JERI ATMANTO TO RISMAN RIPANDI 8888298 100,000.00 0.00 13,314,683.00
ESB:NBMB:0001500F:591164864159

02/10/23 21:56:53 NBMB JERI ATMANTO TO HANDI SETIYAWAN 8888403 100,000.00 0.00 13,214,683.00
ESB:NBMB:0001500F:591434997417

02/10/23 22:17:19 BRIVA88810085393908088NBMBDNID ABDX KARX 8888379 90,000.00 0.00 13,124,683.00

BRIVA 88810085393908088NBMBDNID ABDX KAR
ESB:NBMB:0200200P:591441631729

03/10/23 08:58:09 NBMB JERI ATMANTO TO HANDI SETIYAWAN 8888437 100,000.00 0.00 13,024,683.00
ESB:NBMB:0001500F:591565439107

03/10/23 11:04:28 BRIVA88810082255621391NBMBDNID HADXX BRIVA 8888028 135,000.00 0.00 12,889,683.00

88810082255621391NBMBDNID HADXX
ESB:NBMB:0200200P:591622208744

03/10/23 18:27:07 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888234 1,000,000.00 0.00 11,889,683.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:591818842232

03/10/23 18:57:25 BRIVA88810085348196022NBMBDNID MISXXX 8888496 90,000.00 0.00 11,799,683.00

BRIVA 88810085348196022NBMBDNID MISXXX
ESB:NBMB:0200200P:591834142007

Created By BRISIM
12/28/2023 11:01:21 AM
 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

Halaman 2 dari 6
Page 2 of 6
Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

03/10/23 18:58:56 BRIVA88810082255621391NBMBDNID HADXX BRIVA 8888575 135,000.00 0.00 11,664,683.00

88810082255621391NBMBDNID HADXX
ESB:NBMB:0200200P:591834902670

03/10/23 19:52:51 NBMB JERI ATMANTO TO HANDI SETIYAWAN 8888401 100,000.00 0.00 11,564,683.00
ESB:NBMB:0001500F:591861562349

03/10/23 21:09:48 BRIVA88810081255031539NBMBDNID BURXXX 8888004 200,000.00 0.00 11,364,683.00

BRIVA 88810081255031539NBMBDNID BURXXX
ESB:NBMB:0200200P:591896167558

03/10/23 21:29:30 NBMB JERI ATMANTO TO DENNY HENDRAWAN 8888051 150,000.00 0.00 11,214,683.00
ESB:NBMB:0001500F:591903820964

03/10/23 22:21:34 BRIVA88810082220297881NBMBDNID JERX ATMX 8888216 50,000.00 0.00 11,164,683.00

BRIVA 88810082220297881NBMBDNID JERX ATM
ESB:NBMB:0200200P:591921052393

04/10/23 10:26:04 BRIVA88810082255621391NBMBDNID HADXX BRIVA 8888515 350,000.00 0.00 10,814,683.00

88810082255621391NBMBDNID HADXX
ESB:NBMB:0200200P:592065914651

04/10/23 19:20:05 BRIVA88810081352279613NBMBDNID ZULXXXXXX 8888006 50,000.00 0.00 10,764,683.00

BRIVA 88810081352279613NBMBDNID ZULXXXXX
ESB:NBMB:0200200P:592291225657

04/10/23 19:46:32 BRIVA88810085348196022NBMBDNID MISXXX 8888456 100,000.00 0.00 10,664,683.00

BRIVA 88810085348196022NBMBDNID MISXXX
ESB:NBMB:0200200P:592303643208

05/10/23 23:59:59 082220297881|4SMS|30/09/2023-02/10/2023 DDY402 2,000.00 0.00 10,662,683.00

06/10/23 00:17:36 QRIS592838985830#9360000210065217668 8888437 100,000.00 0.00 10,562,683.00

ESB:NBMB:0007I00P:592838985830

06/10/23 20:38:52 BRIVA88810081255031539NBMBDNID BURXXX 8888335 140,000.00 0.00 10,422,683.00

BRIVA 88810081255031539NBMBDNID BURXXX
ESB:NBMB:0200200P:593213638466

07/10/23 08:21:14 QRIS593338069425#9360000210065217668 8888067 100,000.00 0.00 10,322,683.00

ESB:NBMB:0007I00P:593338069425

07/10/23 09:54:17 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888581 1,000,000.00 0.00 9,322,683.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:593369171365

07/10/23 10:48:29 5379412099679762#000000007735#ATM #TRFLA 0888282 0.00 500,000.00 9,822,683.00

TRF BERSAMA FROM AVEN DARMAWAN LA
459901016255535ATM 5379412099679762

07/10/23 11:16:28 601301304095360100050925 0212974 2,000,000.00 0.00 7,822,683.00

08/10/23 07:44:46 BRIVA88810085348241872NBMBDNID SURXXXXXX 8888270 500,000.00 0.00 7,322,683.00

BRIVA 88810085348241872NBMBDNID SURXXXXX
ESB:NBMB:0200200P:593740320843

08/10/23 09:24:52 QRIS593768191634#9360000210065217668 8888154 100,705.00 0.00 7,221,978.00

ESB:NBMB:0007I00P:593768191634

08/10/23 15:48:49 BRIVA88810008115988878NBMBDNID ANSXX BRIVA 8888071 300,000.00 0.00 6,921,978.00

88810008115988878NBMBDNID ANSXX
ESB:NBMB:0200200P:593891759357

08/10/23 20:39:01 NBMB JERI ATMANTO TO YEYEN HERMANSYAH 8888595 100,000.00 0.00 6,821,978.00
ESB:NBMB:0001500F:594002075133

Created By BRISIM
12/28/2023 11:01:21 AM
 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

Halaman 3 dari 6
Page 3 of 6
Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

09/10/23 19:11:39 BRIVA88810082220297881NBMBDNID JERX ATMX 8888159 200,000.00 0.00 6,621,978.00

BRIVA 88810082220297881NBMBDNID JERX ATM
ESB:NBMB:0200200P:594388156367

09/10/23 19:17:49 NBMB JERI ATMANTO TO MUHAMMAD ALI 8888576 980,000.00 0.00 5,641,978.00
ESB:NBMB:0001500F:594391036998

09/10/23 19:50:11 QRIS594405822796#9360000210065217668 8888270 100,000.00 0.00 5,541,978.00

ESB:NBMB:0007I00P:594405822796

09/10/23 23:59:59 082220297881|1SMS|03/10/2023-03/10/2023 DDY402 500.00 0.00 5,541,478.00

10/10/23 07:54:02 NBMB YANDI SETIAWAN TO JERI ATMANTO 8888325 0.00 700,000.00 6,241,478.00
ESB:NBMB:0001500F:594547071189

10/10/23 11:24:18 BRIVA88810081255031539NBMBDNID BURXXX 8888459 180,000.00 0.00 6,061,478.00

BRIVA 88810081255031539NBMBDNID BURXXX
ESB:NBMB:0200200P:594630545952

10/10/23 18:40:22 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888047 600,000.00 0.00 5,461,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:594820369941

10/10/23 19:38:55 NBMB JERI ATMANTO TO SUBUR 8888382 100,000.00 0.00 5,361,478.00
ESB:NBMB:0001500F:594849799816

10/10/23 19:57:01 BRIVA88810081348926697NBMBDNID MUHXXXXX 8888293 100,000.00 0.00 5,261,478.00

BRIVA 88810081348926697NBMBDNID MUHXXXXX
ESB:NBMB:0200200P:594858550372

10/10/23 20:02:54 NBMB JERI ATMANTO TO MUHAMMAD ALI 8888437 1,000,000.00 0.00 4,261,478.00
ESB:NBMB:0001500F:594861384688

10/10/23 20:32:11 QRIS594875115628#9360000210065217668 8888200 85,000.00 0.00 4,176,478.00

ESB:NBMB:0007I00P:594875115628

10/10/23 21:00:17 BRIVA88810085787586842NBMBDNID LUKXXX 8888511 135,000.00 0.00 4,041,478.00

BRIVA 88810085787586842NBMBDNID LUKXXX
ESB:NBMB:0200200P:594887345367

11/10/23 09:18:52 BRIVA88810085348241872NBMBDNID SURXXXXXX 8888228 500,000.00 0.00 3,541,478.00

BRIVA 88810085348241872NBMBDNID SURXXXXX
ESB:NBMB:0200200P:595026765096

11/10/23 13:23:46 NBMB JERI ATMANTO TO SUBUR 8888136 100,000.00 0.00 3,441,478.00
ESB:NBMB:0001500F:595123776117

11/10/23 14:17:20 BRIVA88810081255031539NBMBDNID BURXXX 8888539 400,000.00 0.00 3,041,478.00

BRIVA 88810081255031539NBMBDNID BURXXX
ESB:NBMB:0200200P:595144183337

11/10/23 15:56:30 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888227 600,000.00 0.00 2,441,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:595182406199

11/10/23 21:31:54 BRIVA88810081255031539NBMBDNID BURXXX 8888219 100,000.00 0.00 2,341,478.00

BRIVA 88810081255031539NBMBDNID BURXXX
ESB:NBMB:0200200P:595322280013

12/10/23 15:38:32 NBMB JERI ATMANTO TO HARFINI SULISTIA 8888374 70,000.00 0.00 2,271,478.00
ESB:NBMB:0001500F:595582923282

12/10/23 16:12:21 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888166 400,000.00 0.00 1,871,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:595595384628

Created By BRISIM
12/28/2023 11:01:21 AM
 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

Halaman 4 dari 6
Page 4 of 6
Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

13/10/23 09:52:23 NBMB JERI ATMANTO TO SUPYANSYAH 8888341 1,000,000.00 0.00 871,478.00
ESB:NBMB:0001500F:595853989909

13/10/23 10:11:40 QRIS595861404152#9360000210065217668 8888273 100,000.00 0.00 771,478.00

ESB:NBMB:0007I00P:595861404152

13/10/23 10:36:20 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888506 300,000.00 0.00 471,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:595871062491

13/10/23 17:28:53 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888420 400,000.00 0.00 71,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:596027924555

13/10/23 23:59:59 082220297881|14SMS|07/10/2023-10/10/2023 DDY402 7,000.00 0.00 64,478.00

15/10/23 08:26:38 PUL-SIM 082220297881NBMB6013013040953601 8888453 1,500.00 0.00 62,978.00

ESB:NBMB:0100101C:596622868798

15/10/23 08:26:38 PUL-SIM 082220297881NBMB6013013040953601 8888453 15,000.00 0.00 47,978.00

ESB:NBMB:0100101C:596622868798

16/10/23 00:00:00 Monthly Fee ATM 2,500.00 0.00 45,478.00

16/10/23 20:27:07 BFST459901016255535ALFENI B :BMRIIDJA 8888633 0.00 2,500,000.00 2,545,478.00

20231016BMRIIDJA010O0221744693
ESB:BFST:0008N:20231016BRINIDJA110148473

16/10/23 23:59:59 Admin Fee 5,500.00 0.00 2,539,978.00

17/10/23 07:57:50 NBMB JERI ATMANTO TO SUPYANSYAH 8888337 500,000.00 0.00 2,039,978.00
ESB:NBMB:0001500F:597385991836

17/10/23 10:08:14 NBMB JERI ATMANTO TO SUPYANSYAH 8888343 500,000.00 0.00 1,539,978.00
ESB:NBMB:0001500F:597431646688

17/10/23 12:36:27 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888019 1,050,000.00 0.00 489,978.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:597489551406

17/10/23 23:59:59 082220297881|3SMS|11/10/2023-13/10/2023 DDY402 1,500.00 0.00 488,478.00

18/10/23 18:36:08 NBMB ADI CANDRA TO JERI ATMANTO 8888338 0.00 5,000,000.00 5,488,478.00
ESB:NBMB:0001500F:598020766626

18/10/23 18:54:46 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888287 1,000,000.00 0.00 4,488,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:598028868756

19/10/23 07:39:13 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888477 4,000,000.00 0.00 488,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:598172880688

19/10/23 12:53:36 QRIS598282571510#9360000210065217668 8888086 100,000.00 0.00 388,478.00

ESB:NBMB:0007I00P:598282571510

19/10/23 16:24:02 5379412099679762#000000006340#ATM #TRFLA 0888045 0.00 500,000.00 888,478.00

TRF BERSAMA FROM AVEN DARMAWAN LA
459901016255535ATM 5379412099679762

19/10/23 19:41:19 QRIS598437520586#9360000210065217668 8888213 200,000.00 0.00 688,478.00

ESB:NBMB:0007I00P:598437520586

20/10/23 01:24:41 NBMB HENRI GUNAWAN TO JERI ATMANTO 8888248 0.00 1,900,000.00 2,588,478.00
ESB:NBMB:0001500F:598524543921

Created By BRISIM
12/28/2023 11:01:21 AM
 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

Halaman 5 dari 6
Page 5 of 6
Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

20/10/23 07:33:08 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888600 800,000.00 0.00 1,788,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:598569968588

20/10/23 13:06:03 BRIVA88810081352279613NBMBDNID ZULXXXXXX 8888449 90,000.00 0.00 1,698,478.00

BRIVA 88810081352279613NBMBDNID ZULXXXXX
ESB:NBMB:0200200P:598692662114

20/10/23 20:22:25 BRIVA88810008115988878NBMBDNID ANSXX BRIVA 8888327 200,000.00 0.00 1,498,478.00

88810008115988878NBMBDNID ANSXX
ESB:NBMB:0200200P:598870254552

20/10/23 22:01:46 NBMB JERI ATMANTO TO RUDIONO FAJAR 8888168 100,000.00 0.00 1,398,478.00
ESB:NBMB:0001500F:598905958916

20/10/23 22:10:47 BRIVA88810082255597089NBMBDNID JUMXX BRIVA 8888320 90,000.00 0.00 1,308,478.00

88810082255597089NBMBDNID JUMXX
ESB:NBMB:0200200P:598908497245

21/10/23 23:59:59 082220297881|6SMS|16/10/2023-18/10/2023 DDY402 3,000.00 0.00 1,305,478.00

22/10/23 08:20:32 NBMB JERI ATMANTO TO MUHAMMAD ALI 8888328 960,000.00 0.00 345,478.00
ESB:NBMB:0001500F:599380482085

22/10/23 08:31:36 QRIS599383140230#9360000210065217668 8888512 100,000.00 0.00 245,478.00

ESB:NBMB:0007I00P:599383140230

22/10/23 21:15:36 BRIVA88810082220297881NBMBDNID JERX ATMX 8888232 136,000.00 0.00 109,478.00

BRIVA 88810082220297881NBMBDNID JERX ATM
ESB:NBMB:0200200P:599624664509

23/10/23 07:59:45 QRIS599713780762#9360000210065217668 8888132 50,000.00 0.00 59,478.00

ESB:NBMB:0007I00P:599713780762

24/10/23 06:52:07 NBMB YANDI SETIAWAN TO JERI ATMANTO 8888334 0.00 500,000.00 559,478.00
ESB:NBMB:0001500F:600092623283

24/10/23 07:09:46 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888214 500,000.00 0.00 59,478.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:600096271164

25/10/23 23:59:59 082220297881|5SMS|19/10/2023-22/10/2023 DDY402 2,500.00 0.00 56,978.00

28/10/23 16:15:35 BFST459901016255535ALFENI B :BMRIIDJA 8888639 0.00 41,800,000.00 41,856,978.00

20231028BMRIIDJA010O0222068279
ESB:BFST:0008N:20231028BRINIDJA110154036

28/10/23 17:26:58 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888398 850,000.00 0.00 41,006,978.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:601989534868

28/10/23 19:07:23 BRIVA88810081348926697NBMBDNID MUHXXXXX 8888340 7,200,000.00 0.00 33,806,978.00

BRIVA 88810081348926697NBMBDNID MUHXXXXX
ESB:NBMB:0200200P:602032755542

28/10/23 21:48:29 QRIS602095355736#9360000210065217668 8888443 100,000.00 0.00 33,706,978.00

ESB:NBMB:0007I00P:602095355736

28/10/23 21:52:09 BRIVA88810081352279613NBMBDNID ZULXXXXXX 8888094 100,000.00 0.00 33,606,978.00

BRIVA 88810081352279613NBMBDNID ZULXXXXX
ESB:NBMB:0200200P:602096457782

29/10/23 06:52:04 QRIS602173487547#9360000210065217668 8888190 100,000.00 0.00 33,506,978.00

ESB:NBMB:0007I00P:602173487547

Created By BRISIM
12/28/2023 11:01:21 AM
 LAPORAN TRANSAKSI FINANSIAL
STATEMENT OF FINANCIAL TRANSACTION

Halaman 6 dari 6
Page 6 of 6
Tanggal Transaksi Uraian Transaksi Teller Debet Kredit Saldo
Transaction Date Transaction Description User ID Debit Credit Balance

29/10/23 10:58:22 601301304095360100050925 0212974 2,000,000.00 0.00 31,506,978.00

29/10/23 10:59:15 601301304095360100050925 0212974 2,000,000.00 0.00 29,506,978.00

29/10/23 11:00:08 601301304095360100050925 0212974 2,000,000.00 0.00 27,506,978.00

29/10/23 23:59:59 082220297881|2SMS|24/10/2023-24/10/2023 DDY402 1,000.00 0.00 27,505,978.00

30/10/23 20:56:22 QRIS602872118019#9360000210065217668 8888305 200,000.00 0.00 27,305,978.00

ESB:NBMB:0007I00P:602872118019

30/10/23 21:42:32 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888587 200,000.00 0.00 27,105,978.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:602888487478

30/10/23 21:43:02 BRIVA88810082239561340NBMBDNID INDXX BRIVA 8888209 1,800,000.00 0.00 25,305,978.00

88810082239561340NBMBDNID INDXX
ESB:NBMB:0200200P:602888645972

31/10/23 00:22:37 BRIVA128082220297881NBMBjXXXXX8 BRIVA 8888526 502,250.00 0.00 24,803,728.00

128082220297881NBMBjXXXXX8
ESB:NBMB:0200200P:602923582240

31/10/23 01:00:42 QRIS602928303653#9360000210065217668 8888339 100,000.00 0.00 24,703,728.00

ESB:NBMB:0007I00P:602928303653

31/10/23 22:53:58 BRIVA88810081348926697NBMBDNID MUHXXXXX 8888352 280,000.00 0.00 24,423,728.00

BRIVA 88810081348926697NBMBDNID MUHXXXXX
ESB:NBMB:0200200P:603360656236

Saldo Awal Total Transaksi Debet Total Transaksi Kredit Saldo Akhir
Opening Balance Total Debit Transaction Total Credit Transaction Closing Balance

15,055,683.00 44,031,955.00 53,400,000.00 24,423,728.00

Terbilang / In Words

DUA PULUH EMPAT JUTA EMPAT RATUS DUA PULUH TIGA RIBU TUJUH RATUS DUA PULUH DELAPAN RUPIAH
TWENTY FOUR MILLION FOUR HUNDRED TWENTY THREE THOUSAND SEVEN HUNDRED TWENTY EIGHT RUPIAH
Biaya materai telah dibayar Lunas
Revenue Stamp Paid

- Apabila terdapat perbedaan dengan catatan Saudara, harap menghubungi kami selambat-lambatnya 14 hari sejak diterimanya rekening koran ini.
- In the case of any differences from your records, please contact us within not later than 14 days from the receipt of this Statement of Account
- Salinan rekening koran ini merupakan hasil cetakan komputer, tidak diperlukan tanda tangan pejabat Bank
- The copy of this Statement of Account is computer-generated, no official signature is required.
- Apabila ada perubahan alamat email mohon diinformasikan pada Unit Kerja BANK BRI
- Should there be any change of email address, please notify the relevant Bank BRI Business Unit

Created By BRISIM
12/28/2023 11:01:21 AM