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0 .
1 2
REALISASI
PROYEKSI (sesuai Jangka Waktu
Obligasi Daerah)
NO. URAIAN
THN (-3) THN (-2) THN (-1) % RATA2 PER- TUMBUH-AN/ TAHUN TAHUN BER-JALAN THN
(1) THN (2) THN (3) THN (4) THN (5)
1 PENDAPATAN
1.1 PENDAPATAN ASLI DAERAH
1.1.1 Pajak Daerah
1.1.2 Retribusi Daerah
1.1.3 Hasil Perusahaan Milik Daerah dan Hasil
1.1.4 Pengelolaan Kekayaan Daerah Yang Dipisahkan
1.1.5 Lain-lain Pendapatan Asli Daerah Yang Sah
1.2 DANA PERIMBANGAN
1.2.1 Bagi Hasil Pajak
1.2.2 Bagi Hasil Bukan Pajak
1.2.3 Dana Alokasi Umum
1.2.4 Dana Alokasi Khusus
1.3 LAIN-LAIN PENDAPATAN YANG SAH
1.3.1 Hibah
1.3.2 Dana Darurat
1.3.3 Dana Bagi Hasil Pajak dari Propinsi dan Pemda
Lainnya
1.3.4 Dana Penyesuaian dan Otonomi Khusus
1.3.5 Bantuan Keuangan dari Propinsi dan Pemda Lainnya
Jumlah
2 BELANJA
2.1 JENIS BELANJA
2.4.1 Belanja Pegawai Negeri Sipil
2.4.2 .Belanja Barang dan Jasa
2.4.3 Belanja Modal
2.4.4 Bunga *
2.4.4.1 PINJAMAN KEPADA DEPKEU
3.2.3.1.1 SLA No………….Tgl …………..
3.2.3.2.1 RDA No………….Tgl …………..
2.4.4.2 PINJAMAN KEPADA PIHAK KETIGA
2.4.5 Subsidi
2.4.6 Hibah
2.4.7 Bantuan Sosial
2.4.8 Belanja bagi hasil dan bantuan keuangan
2.4.9 Belanja tidak terduga
Jumlah
3 SURPLUS /DEFISIT
4 PEMBIAYAAN
3.1 PENERIMAAN DAERAH
3.1.1 Sisa Lebih Perhitungan Anggaran Th. Lalu
3.1.2 Transfer Dari Dana Cadangan
3.1.3 Penerimaan Pinjaman dan Obligasi
3.1.4 Hasil Penjualan Aset Daerah Yg Dipisahkan
3.1.5 Penerimaan Piutang
3. 2 PENGELUARAN DAERAH
3.2.1 Transfer ke Dana Cadangan
3.2.2 Penyertaan Modal (investasi) Pemerintah Daerah
3.2.3 Pembayaran Hutang Pokok Yg Jatuh Tempo *
3.2.3.1 PINJAMAN KEPADA DEPKEU
3.2.3.1.1 SLA No………….Tgl …………..
3.2.3.2.1 RDA No………….Tgl …………..
3.2.3.2 PINJAMAN KEPADA PIHAK KETIGA
5
Sisa Lebih / Kurang Perhitungan Anggaran Thn
REALISASI
PROYEKSI (sesuai Jangka Waktu
Obligasi Daerah)
NO. URAIAN
THN (-3) THN (-2) THN (-1) % RATA2 PER- TUMBUH-AN/ TAHUN TAHUN BER-JALAN THN
(1) THN (2) THN (3) THN (4) THN (5)
6 PERHITUNGAN DEBT SERVICE COVERAGE RATIO
(DSCR)
DSCR = (PAD+DAU+(DBH-DBHDR)) - BELANJA
P + B + BL
PAD = Pendapatan Asli Daerah
DAU = Dana Alokasi Umum
DBH = Dana Bagi Hasil
DBHDR = Dana Bagi Hasil Dana Reboisasi
BELANJA = Belanja PNS
P = Amortisasi Pokok Obligasi Daerah **
B = Bunga Obligasi Daerah
BL = Biaya Lain
DCSR
7 PAGU PINJAMAN BERDASARKAN PP 54/2005
1. Penerimaan APBD Tahun (-1)
2. DAK
3. Dana Darurat
4. Dana Pinjaman Lainnya
5. Penerimaan Lain yang Kegunaannya Dibatasi
6. Penerimaan Umum Tahun 2004 (1-(2+3+4+5))
7. 75% dari butir 6
8. Pinjaman Lama
9. Pinjaman Baru
10. Kesimpulan
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A $2053)1(+% A $2053)1(+%
E &1( (9(
EE !1!1 5.&6(2& (0#(7 9&5(>(#1(+ 9(.(" 50+)31 #$ % *(9( (17&# <(+61( =(1)3
5.&6(2& (0#(7 (.(" *0#7&)3+6(+ *0#1&#((+ 20)&(* )(73+ *!1!1 7(#32 9&*0#7&)3+61(+
20!.(7A!.(7 "0#3*(1(+ (+623#(+ 20)&(* )(73++>( "&2(.+>( 90+6(+ "0"5(6& *!1!1 90+6(+
<3".(7 )(73+ <(+61( =(1)3 5.&6(2& (0#(7
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