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Western

Indonesia t{ational

Roads

Improvement prcject

Loan

IBRD

No.

8043-ID

Spmial Account

Activity Statement

for the

Repofting period of

fuly - September

2015

Bank Indonesia Account No: 601.306.4ii.9S0

a

WINRIP

I

in

USD

I

t

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T

J. Cummulative advances to end of current reporting period 2. Curnmulative expenditures to end of last reporting period 3. Outstanding advances to be accounted (1-2)

Part

II

4. opening sA balarrce at beginning of repofting period (as of July 01, 2015) 5. AddlSubstract:Cummulative adjustmenb (if

any)

*)

6.

Advances from the World Bank during reporting period

7. add 5 and 6

8. Oubtanding advarrces

b be accounted

for

(4+l)

9. Closing SA balance at end of curent reporting (as of Sept 3e 2015) 10. Add/substract; cummulatine adjusment (if

any)

**)

11.

Expenditures for cunent reporting

perid

12. Add 10+11 13. Add 9+12

14. Diffierence (if any)

8-f3

*x*)

Pail

III

15. Total Forecasted amount to be paid by World Bank 16. Less: Closing SA balance after adjustment

17.

Cummulative adjustment (if

any)

****)

18. Add 16+17

19. Cash rcquirement ftom WB for next six months (15-18)

Rounding

4,294,990.93 2,563,51L.53 L,72L,339.30

1,380,000.00

.

L,151,235.66

570,103.64

570,103.64 L,72L,339.30

1,151,235.66 1,151,235.66

L,L'L,235.66

* _Frplanation_fur_{item 5}_(if_{not zero}

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World

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Advice

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Indonesia

Project

:

P090990

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Roads

Improvement

Project

To:

Directorate General of Debt Management

Ministry of Finance

BORROWER OF RECORD

Email

Address:

wdjnrk@yahoo.com

ff

the

beneficiary

name

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witl

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if

the amount

is greater than the

amouDt

specified

in yout application,

please

contact

us

immediately.

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is not

necessary

to contact

us

if

the

above information is correct.

Emall

Fex

phone

loaeap@worldbant.cg

202-522-1645

mZ4S8-1778

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Abbreviations

Used

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USD

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Indonesia

United States Dollars

Indonesian Rupiah

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IBRD

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Reference:

fi)9/11-WINRIP/17

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Transaction

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_Value

Date:

_15-JuI-2015

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USD

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fndonesian

Rupiah

Documented

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24-.Iul-2015

World

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Country:

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Project

:

P090990

-Western

Indonesia

National

Roads

fmprovement

Project

To:

Directorate General of Debt Managernent

Ministry of Finance

BORROWER OF RECORD

Email

Address:

wdjnrk@yahoo,com

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flderv

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Indonesia

Indonesian Rupiah

Borrower

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010/01.WINRIP/U

WB

Transaction

Number:

0049

Application

type:

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Payment

Transaction Value

Date:

24-Jul-2015 Loan Balance as

of

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Applicatiou

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Indonesian

Rupiah

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Amount

Indonesian

Rupiah

3,3921139,t67 3,382,139,867

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08-Sep-201S

World

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Country:

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koject

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P090990

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rndonesia

National

Roads

rmprovement

hoject

To:

Directorate General of Debt Managernent

Minisfiy

of Finance

BORROWER OF RECORD

Email

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wdjnrk@yahoo.com

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ID

USD

IDR

Indonesia

United States Dollans Indonesian Ruptah

Loan:

Borrower

Reference:

WB

Transaction

Number:

IBRD

Loan

E0430ID

011/01.Wn{RIP/r7

0052

Application

type:

Direct payment

TransactionValueDate:

08-Sep-2015

of

0E.Sep-2015: _USD

Application

Amount

fudonesian

Rupiah

_Z34L,OE6,SZL

Documented

Amount

Indonesian

Rupiah

2$4l,0g6,3j29

Category

Application

Currency

Amount

Commitment

165,952.11

Application Amount:

Paid

Amount:

Beneficialy;

.

Cost

Currency

USD

21341,096,329 2,3411096,329

PT

JAYA

KONSTRT]KSI

MANGGALA

Cost

Currency Details

Amount

in

cost

ccy

Exchange

Rate

commitment

ccy

165,952.11 I.00000000

usD

TOTAL

of

Cost

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Amount

in

Commitment Ccy

165,952.11 165,952.11

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World

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Advice

Country:

Indonesia

koject

: P090990'western

rndonesia Nationar Roads

Inprovement

project

To:

Ministry

of

Filance

BORROWER OF RECORD

Email

Address:

wdjnrk@yahoo.com

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ID

USD

IDR

Indonesia

Indonesian Rupiah

Loan:

Borrower

Reference:

WB Transaction Nnrnber:

IBRD

Loan

80430ID

012/01-WINRIP/l7

0057

Application

{pe:

Direct

payment

Transaction

Value

Date:

2B-Sep-2015 745.12

Undisbursed Loan Balance as

of

2015:

USD

2

Application

Amount

Indonesian

Rupiah

Documented

Amount

Indonesian

Rupiah

Category

Application Currenry

IDR

g,2Eg,g0g,30g usD

_56g.6g4.42

Paid

Amounfi

Indonesian

Rupiah

gr2ggrg0g,30g

Beneficlary:

pT JAYA KONSTRUKSIMANGGALA.

Cost

Currency Details

Amouut

in

cost

ccy

Exchange

Rate

commitment ccy

569,6U.42

1.00000000

usD

TOTAL

Total USD

Equivalent

of Cost

Curyry_Alqount:

569.6g4.42 Cost

Currency

USD

Amount

in

Commitment

Ccy

569,684.42 569,694.42

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is not

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us

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above

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is

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(28)

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1280086000046

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Indonesia

hoject

:

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-I{estern

Inilonesia National

Roads

Improvement

Project

To:

Ministry of Finanoe

BORROWER OFRECORD

Email

Address:

wdjnrk@yahoo.com

If

the

beneficiary nanrc or currency is not consistent

with

if

the amount

is

greater

than the

amount specified

in

your

application,

please

contact

us

immediately.

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is not

necessary

to

contact

us

if

the

above

fufomration is correct.

Enrtl

Fax

Phone

loacap@worlrlbank.org

2OL522-l&5

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Abbreviations

Used

ID

USD

IDR

fndonesia

United States Dollars Indonesian Rupiah

Loan:

IBRD

Loan

80430

ID

Borrower

Reference:

O10/02-WINRIP/06

Application

tlTe!

Direct

Payment

WB

Transaction

Number: 004E

Transaction

Value

Date:

2y''-Jril-2015

Loan

Balance asi

of

24-Iril-2D15:

USD

223.155.A89.59

Application

Amount

Indonesian

Rupiah

Documented

Amount

Indonesian

Rupiah

L2,734,026900 L2,734,026900

Amount

Commifuient

Ccy

957,373, 957.373.

6s

65

Appflcadon

Anounh

Iniloneslu

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L2J3'O2690O

PaftlArnounf

Indon.don

Rupirh

12J94,(026z90O

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PT

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KONSTIIIXSIMANGGAIA.

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Satker

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KEPPRES NO.42 TAHUN

2002

r

(01) _{DrpANo. DrpA_033.04.1}

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TANGGAL 14-1 1-2014 REV.3

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1

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4

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i

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PENGELUAMN

POTONGAN

BA. _{Unit. Lok.Aku n.Satker}

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TBK)

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lGSep-20lS

World

Bank

Payment

Advice

Country:

fndonesia

Project

: P090990

-western

rndonesia

National

Roads

rmprovement

project

To:

Directorate General

of

Debt Managernent

Ministry

of Finance

BORROWER OF RECORD

Email

Address:

wdjnrk@yahoo.com

t

I

Abbreviations

Used

ID

USD

IDR

Indonesia

Indonesian Rupiah

Loan:

IBRD

Loan

B0430ID

Borrower

Reference:

011/02-WINRIP/06

WB Transaction

Number:

₀₀₅₄

Application

t5pe:

Direct

Payment

TransactionValueDate;

16-Sep-2015

Loan

Balance as

of

16-Sep.20lS= USD

Application

Arnount

Indonesian

Rupiah

Documented

Amount

Indonesian Rupiah

Category

Applicatiorr Currency

7,609,797,900

7,60g,7g79g0

Amount

Commitment

Ccy

Application Amount:

lndonesian

Rupiah 7,6A9,797,900 Paid

Amount:

fndonesian

Rupiah

1,16}g17g71900

Beneficiarv;

.

PTJAYAKONSTRUKSIMANGGALA

,

Cost

Currency Details

Cost

Currency

Amount

in

Cost

Ccy

Bxchange

Rate

Commitrnent

_Ccy

usD

533,950.03 1.00000000

usD

TOTAL

Total USD

Eqrlivalent of

Cost

Currency Amounft

533,950.03

Amount

in

Comrnitment Ccy

533,950.03 533,950.03

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your application,

please

contact

us

immediately.

It

is not

necessary

to contact

us

if

the

above

information

is coffect.

Email

Fax

(35)

Manggopoh

-

Padang Sawah

40-06/03-WrN Rrp-wp

l/cE/A/so

43-rD

I

L2- L3

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PENGELUARAN POTONGAN

lqnis

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Jumldh Uanq

BA.Unit,Lok.Akun.Satker

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0 15, 04.08-55.4 1

t2tr.567982

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JAYA KONSTRUKSI MANGGALA PMTAMATBKTaman Bintaro Raya Gedung

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NPWP

: 01.362.643.7-054.000

Rekening

:

1280086000046 (PT, JAYA KONSTRUKSI MANGGALA PMTAMA TBK)

Bank/Pos

; Bank Mandiri Cabang Jakarta Bintaro Jaya

Uraian

: Pembayaran Belanja Modal sesuai Kontrak No. 40-06/03-wlNRlp-wpucElA1BO43-ID112

No. KU. 05. 02/03-wIN RI P/PPK. 10-PRM/08/VII/20 1 5 T gt. 24-07-20 1 s.

13 Tgl. 06-L2-2

.389.033,-ta

12330

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BAP

.' :i : ..i

Semua bukti-bukti pengeluaran yang disahkan Pejabat Pembuat Komitmen telah diujidan dinyatakan memenuhi persyaratan untuk dilakukan pembayaran atas beban APBN, selanjutnfa bukti-bukti pengeluaran dimaksud disimpan dan ditatausahakan oleh.Pejabat Penandatangan SPM.

Kebenaran perhitungan dan isi yang teftuang dalam SPM ini menjadi tanggung jawab _{Pejabat Penandatangan}_SPM.

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Emailed:

27-Irn-2015

World

Bank

Payment Advice

Country:

fndonesia

hoject

:

P09(D90 -Western

Indonesia National

Roails

fmprovement

project

To:

Ministry

of Finance

BORRO1VER OF RECORD

Email Address:

wdjnrk@yahoo.com

If

the

beneficiary name or currcncy is not consistent

with

yorn application" or

if

the amount

is greater

then the

amount specified

in

your application, please contact us imrnediately.

It

is

not necessary

to contact

us

if

the

above

infomration is correct.

Emril

Far

Pbone

loaeap@worldbank.orq

202-522-lg5

m2459-t77E

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Abbreviations Used

ID

USD

IDR

Indonesia

United States Dollats

Iudonesian Rupiah

Loan:

IBRD Loan E0430II)

Borrower

Reference:

011/03-WII\RIP/06

Application

type:

Direct

_Payment

WB

Transaction

Number: 0050

_{Transaction Value}

Date:

_27-Jul-2015 Balance as

of

27-Irrl-2015:

USD

222.573.329.76

7,7531113,200

7,753,113';0A

7,753,113,20tn

Application

Amount:

lndonesian

Rupiah

71753,113200

Paid

Amounfi

fndonesian

Rupiah

T,7SSrll3p}O

Benefieiaryr

FT

JAYA KONSTRUKSI

MANGGALA

Cost Currency Details

Cost

Currency

Amount in

Cost

Ccy

Exchange

Rate

Commitment

Ccy

usD

581,7s9.83 I.00000000

usD

TOTAL

Total USD

Equivalent of

Cost

Currency Amount:

SEI,ZSS.B3

Amount

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43

BER 2015 ,Anggaran

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Dasar Pembayaran _Satker

498579

Kewenangan

KP

KEPPRES NO.42 TAHUN 2OO}

(01)

DIPANo. DipA-033.04.

r.4glstg

_1201s TANGGAL 14-11-2014 REV.3

NO. _{DrPA-033.04. r.49857}₉_/

z}rs

Nama Satker

PEI-AKSANMN JAI-AN NASIONAL WILAYAH

I

_PROWilff

SUMBAR

-_'.'.:

04

oB

033

04

Kegiatan, Output, Lokasi

2409 009

08.5s Jenis Pembayaran

Sifat Pembayaran

Sumber Dana

I

Cara penarikan

Nomor Register

1

Pengeluaran Anggaran

4

_{Pembayaran Langsung (LS)}

03.0

RMP

/

RM

10842601

POTONGAN

Jumlah Ua

BA. Unit. Lok.Aku n. Satker

Kepada

NPWP

Rekening

Ban(Pos

Uraidn

64.59s.17?,-

275.3L7.?.39,-3edunss,

li.uiffi

0L.362.643.7-054.000

1280086000046 _{(PT. JAYA KONSTRUKSi MANGGALA}_PMTAMA

TBK) Bank Mandiri Cabang Jakarta _{Bintaro Jaya}

Pembayaran Belanja Modat sesua

j t(ojtFl,,I9:_!0

_06/03:Wrl!RI? _v!ptlCr/A/8043_rD

/r2_r3Tsr.

06_12_2013, BAp

No, KU. 0 5. 02/03-wr N Rr p/p pK. 1 0_ pRMioslixT)o _i

s-iiti.

_{03_0s_20}

1 s.

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Emailed:

L6-Sep-2015

World

Bank

Payment

Advice

Country:

Indonesia

Project

: P090990

-Western Indonesia National

Roads

Improvement Project

To:

Ministry of

Finance

BORRO\ryER OF RECORD

Email Ad.dress:

wdjnrk@yahoo,coru

Alrpllcrdon

Anount

Inrloncdan

Rnplah

7p0E/46,700

Paid

AmoErt

hdoncdrr

Ruptrh

TeWAl'JUt

.Benefdary;

-FTJAYAKONSTnIIKSIMA.NGGAI"A...

Cost

Currengpgsjts

cost

currency

Anount

ln

coct

ccy

helange

Rate

commrhrcnt

ccy

Anount

rn

CoEmlhent

Ccy

usD

s05,8ss9r l.m00m00

usD

s05,855.91

TOTAL

505.155.9r

Ifthe

beneficiary

name

ot

cuntetrcy

is not consistent s/ith your application, or

if

the amount is greater than the

amount specified

in

your aprplication,

please

contact

us

immediately.

It

is

not

necessary

to contact

us

if

the

above

information

is correct.

Enrll

F

r

phone

loaeao@worklbank.ors

2@-522-1645

2n2458-I77t

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Abbreviations

Used

ID

USD

IDR

Indonesia

United States Dollzus Indonesian Rupiah

Loan:

IBRD

Loan B0430ID

Borrower

Reference:

012/03-WINRIP/06

Application

type:

Direct payment

WB Transaction

Number: 0053

Transaction

_Value

Date:

_16-Sep-2015

toan

Balance as

of

16-Sep-2015:

Application

Amount

Indonesian

Rupiah

DocumentedAmount

IndonesianRupiah

Category

AppHcation

Currency

7,209A46,700

7208446J00

(42)

Ipuh -

Bantal

0

r-26

I 04-Wr

N Rr

p-Wp

l/cE/A/eo

$

|

Ll

- 1

3

Tanggal

14 November

2013

(43)

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d.a

til

*

WINRIP DOC IFR CTC IFR Q3 Jul Sep 2015 20150930 00309

TECHNICAL ASSTSTANCE FOR SUPPORT OF THE PROJECT MANAGEMENT UNIT

H qHHqqq888888888888

C HSHi

s8Nss$tqR{HRg:SaR4tD:

ilEN+CSS$S"'-Ng'Bd's-=S-+

WINRIP

b be accounted

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rir{'cl*

BORROWER OF RECORD

Email

loaeap@worldbant.cg

Rupiah

$iiu ftink

i*nrup

Country:

BORROWER OF RECORD

Email

TOIAL

infomration is correct.

qd.rrqt

*tAfi*sfil-A

Advice

BORROWER OF RECORD

Email

Commitment

curnency

FHf;fid&ftY&fi

l i,iitr

: trsilflFsfrj$04{

BS,FII{:

t'i,{f{[rtu

Emailed:

BORROWER OF RECORD

Email

Application Currenry

curency

Bridge

PENGELUARAN

xqllt+

DANG, 29 JUU

lttoo:

BORROWER OFRECORD

Email

loacap@worlrlbank.org

Rupiah

Satker

KEPPRES NO.42 TAHUN

.4s}s7qil2l1s

TANGGAL 14-1 1-2014 REV.3

r.5o7gei

A.n. Kua\{

BORROWER OF RECORD

Email

lndonesian

amount is

KEPPRES N0.42 TAHUN

Satker

PENGELUARAN POTONGAN

lqnis

Emailed:

BORRO1VER OF RECORD

Email Address:

IBRD Loan E0430II)

TOTAL

*XXDUA

Belania

KEPPRES NO.42 TAHUN 2OO}

r.4glstg

PEI-AKSANMN JAI-AN NASIONAL WILAYAH

SUMBAR

POTONGAN

275.3L7.?.39,-3edunss,

tAfisfil-A