a-015/pge000/2018-s9pge.pertamina.com/uploads/b3d7ce70-0c4d-424f-8be6-71e3e... · 2020. 8. 27. ·...
TRANSCRIPT
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Lampiran 1 – Pedoman Np. A-015/PGE000/2018-S9 Rev.0
FORM I NOMOR PGE500-001/2018
PELAPORAN PENERIMAAN HADIAH / CINDERAMATA DAN/ATAU HIBURAN (ENTERTAIMENT) REVISI 00
Kepada : Unit Pengendalian Gratifikasi PT Pertamina Geothermal Energy (UPG PGE) Sesuai dengan Pedoman Gratifikasi, Penolakan, Penerimaan, Pemberian Hadiah/Cinderamata dan/atau Hiburan (Entertaiment) PT. Pertamina Geothermal Energy yang berlaku saat ini, saya yang bertanda tangan di bawah ini menyampaikan laporan penerimaan Hadiah/cinderamata dan/atau Hiburan (entertaiment) sebagai berikut : Nama : No. Pekerja : Jabatan : Unit Kerja : Email : No. HP : Nama Atasan Langsung : 1. Hadiah/cinderamata dan/atau Hiburan (entertaiment) yang diterima sebagaimana tercantum dalam Tabel di bawah ini :
NO TANGGAL LOKASI PENERIMAAN
NAMA/BENTUK BENDA
GRATIFIKASI
NILAI BENDA GRATIFIKASI
JUMLAH BENDA
GRATIFIKASI
PEMBERI BENDA
GRATIFIKASI
HUBUNGAN DENGAN PEMBERI
KETERANGAN
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Catatan : 2. Apakah penerimaan Hadiah/cinderamata dan/atau Hiburan (entertaiment) dimaksud telah diketahui oleh atasan Saudara?
Ya / Tidak* ...................., ....................... 2018 Pelapor (..................................) Tembusan : (atasan langsung pelapor) *) Coret yang tidak perlu
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Lampiran 2 – Pedoman Np. A-015/PGE000/2018-S9 Rev.0
FORM II NOMOR PGE500-002/2018
PELAPORAN PEMBERIAN HADIAH / CINDERAMATA DAN/ATAU HIBURAN (ENTERTAIMENT) REVISI 00
Kepada : Unit Pengendalian Gratifikasi PT Pertamina Geothermal Energy (UPG PGE) Sesuai dengan Pedoman Gratifikasi, Penolakan, Penerimaan, Pemberian Hadiah/Cinderamata dan/atau Hiburan (Entertaiment) PT. Pertamina Geothermal Energy yang berlaku saat ini, saya yang bertanda tangan di bawah ini menyampaikan laporan pemberian Hadiah/cinderamata dan/atau Hiburan (entertaiment) sebagai berikut : Nama : No. Pekerja : Jabatan : Unit Kerja : Email : No. HP : Nama Atasan Langsung : 1. Hadiah/cinderamata dan/atau Hiburan (entertaiment) yang diberikan sebagaimana tercantum dalam Tabel di bawah ini :
NO TANGGAL LOKASI PEMBERIAN
NAMA/BENTUK BENDA
GRATIFIKASI
NILAI BENDA GRATIFIKASI
JUMLAH BENDA
GRATIFIKASI
PENERIMA BENDA
GRATIFIKASI
HUBUNGAN DENGAN
PENERIMA KETERANGAN
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Catatan : 2. Apakah pemberian Hadiah/cinderamata dan/atau Hiburan (entertaiment) dimaksud telah diketahui oleh atasan Saudara?
Ya / Tidak* ...................., ....................... 2018 Atasan Langsung Pelapor (.............................) (..................................) *) Coret yang tidak perlu
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