| {NAMA_MAHASISWA} | / | {NIM} | |
| {NAMA_FAKULTAS} | {NAMA_PROGRAM_STUDI} | ||
| {PERIODE} | {REALNAME} |
| {NO} | {NO_INVOICE} | {TAGIHAN} | {NOMINAL} |
| {TOTAL_TAGIHAN} | {TOTAL_PEMBAYARAN} | ||
|
___________________ Finansi Departement |
___________________ {NAMA_MAHASISWA} |
_______________ |
| (), () |