This is a payment and cash advance form from PT. Anak Jaya Bapak Sejahtera. It contains fields for a cash advance number, payment number, document date, request name, division, date, cost center, customer number, general ledger account, information, quantity, unit price, total, receiver, payment method, bank name, account number, due date, and sections for request, receiver, approval, acknowledgement, and issuance/input signatures and dates.

1. PT. ANAK JAYA BAPAK SEJAHTERA
PAYMENT & CASH ADVANCE FORM
Cash Advance No :
Payment Number :
Doc. Date :
Request Name :
Division :
Date Cost Center
Cust
No
GL Acc
Informations
Rupiah
Specs QTY Rp / Unit
Total
Receiver :
Payment Methods : Cash / Cheque / Giro / Transfer
Bank Name :
Account No
Due Date :
Request Receiver Approved by Acknowledge by Issued & Input by
Date Date Date Date Date Date Date