Invoice Speech Therapist in Indonesia Jakarta –Free Word Template Download with AI
Service Provider (Speech Therapist)
Dr. Anindya Prasetyo, M.Si., CCC-SLP
Certified Speech Therapist & Language Pathologist
PT. Jakarta Speech & Communication Center
Jl. Jend. Sudirman Kav. 52-53, Tower B, Floor 12
Setiabudi, Indonesia Jakarta, 12190
Tel: +62-21-520-8844
Email: [email protected]
NPWP: 02.445.678.9-012.000
Bill To (Client)
PT. Nusantara Education Foundation
Attn: Mrs. Ratna Wulandari, Program Director
Jl. Gatot Subroto No. 88, Menteng
Indonesia Jakarta, 10310
Tel: +62-21-390-5566
Email: [email protected]
NPWP: 09.112.345.6-013.000
Speech Therapist Service Breakdown – Indonesia Jakarta
| No. | Description of Speech Therapist Service | Date of Service | Qty | Unit Price (IDR) | Amount (IDR) |
|---|---|---|---|---|---|
| 1 | Initial Speech and Language Assessment for pediatric patient (age 4-6) conducted by licensed Speech Therapist at Indonesia Jakarta clinic facility | 02 Jun 2025 | 1 session | 1,500,000 | 1,500,000 |
| 2 | Individual Speech Therapy Session – Articulation and Phonological Intervention (45 minutes) delivered by Speech Therapist in Indonesia Jakarta | 03 Jun 2025 | 4 sessions | 850,000 | 3,400,000 |
| 3 | Group Speech Therapy Program – Social Communication and Pragmatic Language Skills for children (60 minutes, max 4 participants) facilitated by Speech Therapist team in Indonesia Jakarta | 05 Jun 2025 | 2 sessions | 1,200,000 | 2,400,000 |
| 4 | Oral Motor Therapy and Feeding Difficulties Intervention by specialized Speech Therapist at Indonesia Jakarta outpatient center | 08 Jun 2025 | 3 sessions | 950,000 | 2,850,000 |
| 5 | Parent Training Workshop – Home-based Speech Therapy Techniques and Communication Strategies (2-hour workshop) led by senior Speech Therapist in Indonesia Jakarta | 10 Jun 2025 | 1 workshop | 2,000,000 | 2,000,000 |
| 6 | Progress Evaluation and Comprehensive Speech Therapist Report – Written clinical documentation of patient milestones, therapy outcomes, and recommended next steps for Indonesia Jakarta program | 12 Jun 2025 | 1 report | 750,000 | 750,000 |
| 7 | Audiological Screening Coordination and Referral Management by Speech Therapist in partnership with Indonesia Jakarta ENT specialists | 13 Jun 2025 | 1 referral | 500,000 | 500,000 |
| Subtotal | IDR 13,400,000 |
| VAT (PPN) 11% | IDR 1,474,000 |
| Administrative Fee (Indonesia Jakarta) | IDR 250,000 |
| TOTAL AMOUNT DUE | IDR 15,124,000 |
Payment Instructions
Please remit the total Invoice amount of IDR 15,124,000 (Fifteen Million One Hundred Twenty-Four Thousand Indonesian Rupiah) within fifteen (15) calendar days from the date of issue.
Bank: Bank Central Asia (BCA)
Account Name: PT. Jakarta Speech & Communication Center
Account Number: 5520-8844-123
Branch: Indonesia Jakarta – Sudirman Branch
SWIFT Code: CBAQIDJA
Please reference the Invoice number INV-JKT-2025-0487 in your transfer memo to ensure proper accounting reconciliation.
Important Notes Regarding This Invoice
1. This Invoice covers all Speech Therapist services rendered between 02 June 2025 and 13 June 2025 at our Indonesia Jakarta facility located in Setiabudi, South Jakarta.
2. All Speech Therapist sessions were conducted in accordance with the Indonesian Ministry of Health regulations (Permenkes No. 14 Tahun 2021) regarding speech and language pathology services.
3. The Speech Therapist team assigned to this program holds valid professional licenses issued by the Indonesian Association of Speech and Language Pathologists (PERSAL).
4. Should any disputes arise regarding the services listed in this Invoice, please contact our billing department in Indonesia Jakarta within ten (10) business days of receipt.
5. Late payments are subject to a penalty of 2% per month as stipulated in the service agreement between both parties.
6. This Invoice is valid for a period of ninety (90) days from the date of issue. After this period, the Invoice must be reissued by our Speech Therapist billing office in Indonesia Jakarta.
⬇️ Download as DOCX Edit online as DOCXCreate your own Word template with our GoGPT AI prompt:
GoGPT