Tiga puluh delapan) macam jenis obat keras daftar G yang terdiri dari :----------------------------------------------------------------NO NAMA OBAT PABRIK JUMLAH1 Incitin PT Bernofarm 200 Tablet2 Zendalat PT Zenith Pharm 200 Tablet3 Farmalat PT Pratapa Nirmala 300 Tablet4 Unthecol PT Bernofarm 100 Tablet5 Zoralin PT Medikon Prima 500 Tablet6 Lanzogra PT Graha Farma 20 Kapsul7 Histigo PT Ifars 40 Kaplet8 Microtina PT Pyridam 100 Kapsul9 Lerzin PT Ifars 1 botol/15 ml10 Omeproksil PT Mutifa

Menyatakan barang bukti berupa : NO NAMA OBAT PABRIK JUMLAH1 Incitin PT Bernofarm 200 Tablet2 Zendalat PT Zenith Pharm 200 Tablet3 Farmalat PT Pratapa Nirmala 300 Tablet4 Unthecol PT Bernofarm 100 Tablet5 Zoralin PT Medikon Prima 500 Tablet6 Lanzogra PT Graha Farma 20 Kapsul7 Histigo PT Ifars 40 Kaplet8 Microtina PT Pyridam 100 Kapsul9 Lerzin PT Ifars 1 botoV/15ml10 Omeproksil PT Mutifa 70 Kaplet11 Griseofulvin 125 PT Indofarm 100 Tablet12 Otoryl 25 PT Otto 200 Tablet13 Gralixa 40 PT Graha Farma

tablet 21056 FG Troches Meiji tablet 7057 Andalan Pil KB Harsen tablet 1058 Vitaquin Cream Surya Dermato tube 459 Pronicy Kalbe Farma tablet 3060 Mycoral 200 mg Kalbe tablet 2061 Unigin Universal tablet 2062 Broadamox Syr Sampharindo btl 763 Etabiotoc Syr Errita btl 864 Mikrodiol KF strip 565 Chloramphecort H KF tube 466 Muzoral Krim 2 % Mugi tube 267 Erlamycetin Plus Erela tube 468 Betason N Cream KF tube 569 Berloson Cream KF tube 670 Neuralgin RX Kalbe tablet 571 Omegtrim Mutifa

Dexamethason Harsen Tablet 210e 0,7556 FG Troches Meiji Tablet 7057 Andalan Pil KB Harsen Tablet 1058 Vitaquin Cream Surya Dermato Tube 459 Pronicy Kalbe Farma/Tablet 3060 Mycoral 200 Kalbe tablet 20mg61 Unigin Universal Tablet 2062 Broadamox SyrSampharindo Btl 763 Etabiotoc Syr Errita Btl 864 Mikrodiol KF Strip 5 65 Chloramphecor KF Tube 4tH66 Muzoral Krim Mugi Tube 22%67 Erlamycetin Erela Tube 4Plus68 Betason N KF Tube 5Cream69 Berloson KF Tube 6Cream70 Neuralgin RX Kalbe Tablet 571 Omegtrim Mutifa

Dexamethasone 0,75 Harsen tablet 21056 FG Troches Meiji tablet 7057 Andalan Pil KB Harsen tablet 1058 Vitaquin Cream Surya Dermato tube 459 Pronicy Kalbe Farma tablet 3060 Mycoral 200 mg Kalbe tablet 2061 Unigin Universal tablet 2062 Broadamox Syr Sampharindo btl 763 Etabiotoc Syr Errita btl 864 Mikrodiol KF strip 565 Chloramphecort H KF tube 466 Muzoral Krim 2% Mugi tube 267 Erlamycetin Plus Erela tube 468 Betason N Cream KF tube 569 Berloson Cream KF tube 670 Neuralgin RX Kalbe tablet a 71 Omegtrim Mutifa

Dexamethason Harsen Tablet 210e 0,7556 FG Troches Meiji Tablet 7057 Andalan Pil KB Harsen Tablet 1058 Vitaquin Cream Surya Dermato Tube 459 Pronicy Kalbe Farma/Tablet 3060 Mycoral 200 Kalbe tablet 20mg61 Unigin Universal Tablet 2062 Broadamox SyrSampharindo Btl 763 Etabiotoc Syr Errita Btl 864 Mikrodiol KF Strip 565 Chloramphecor KF Tube 4tH66 Muzoral Krim Mugi Tube 2 2% 67 Erlamycetin Erela Tube 4Plus68 Betason N KF Tube 5Cream69 Berloson KF Tube 6Cream70 Neuralgin RX Kalbe Tablet 571 Omegtrim Mutifa

Dexamethasone 0,75 Harsen tablet 21056 FG Troches Meiji tablet 7057 Andalan Pil KB Harsen tablet 1058 Vitaquin Cream Surya Dermato tube 459 Pronicy Kalbe Farma tablet 3060 Mycoral 200 mg Kalbe tablet 2061 Unigin Universal tablet 2062 Broadamox Syr Sampharindo btl 763 Etabiotoc Syr Errita btl 864 Mikrodiol KF strip 565 Chloramphecort H KF tube 466 Muzoral Krim 2% Mugi tube 267 Erlamycetin Plus Erela tube 468 Betason N Cream KF tube 569 Berloson Cream KF tube 670 Neuralgin RX Kalbe tablet a71 Omegtrim Mutifa

Mutifa 5 Botol31 Cotrimoxazol Suspensi PT. Phyto Kemo Agung Farma 33 Botol32 Zinochlor Suspensi PT. Zenith Pharmaceutical 12 Botol33 Lexapram Sirup PT. Molex Ayus Pharmaceutical 8 Botol34 Fasiprim Suspensi PT. Ifars Pharmaceutical Laboratories 18 Botol35 ampicillin PT. Rama Emerald Multi Sukses 150 Kaplet36 Thiamicin 500 PT. Interbat 30 Kapsul37 Griseofulvin 125 mg PT. Indofarma 200 Tablet38 Supertetra PT. Darya Varia 78 Soft Capsule39 Mycrogynon Tablet PT.

Mutifa 5 Botol31 Cotrimoxazol PT. Phyto Kemo Agung Farma 33 BotolSuspensi32 Zinochlor Suspensi PT. Zenith Pharmaceutical 12 Botol33 Lexapram Sirup PT. Molex Ayus 8 BotolPharmaceutical34 Fasiprim Suspensi PT. Ifars Pharmaceutical 18 BotolLaboratories35 ampicillin PT. Rama Emerald Multi 150 KapletSukses36 Thiamicin 500 PT. Interbat 30 Kapsul37 Griseofulvin 125 mg PT. Indofarma 200 Tablet38 Supertetra PT. Darya Varia 78 SoftCapsule39 Mycrogynon Tablet PT.

Mutifa 5 Botol Obat keras31 Cotrimoxazol PT. Phyto Kemo 33 Botol Obat kerasSuspensi Agung Farma32 Zinochlor Suspensi PT. Zenith 12 Botol Obat kerasPharmaceutical33 Lexapram Sirup PT. Molex Ayus 8 Botol Obat kerasPharmaceutical34 Fasiprim Suspensi PT. Ifars 18 Botol Obat kerasPharmaceuticalLaboratories35 Ampicillin PT. Rama Emerald 150 Kaplet Obat kerasMulti Sukses36 Thiamicin 500 PT. Interbat 30 Kapsul Obat keras37 Griseofulvin 125 mg PT. Indofarma 200 Tablet Obat keras38 Supertetra PT.

Mutifa 5 Botol31 Cotrimoxazol Suspensi PT. Phyto Kemo Agung 33 BotolFarma32 Zinochlor Suspensi PT. Zenith Pharmaceutical 12 Botol33 Lexapram Sirup PT. Molex Ayus 8 BotolPharmaceutical34 Fasiprim Suspensi PT. Ifars Pharmaceutical 18 BotolLaboratories35 Ampicillin PT. Rama Emerald Multi 150 KapletSukses36 Thiamicin 500 PT. Interbat 30 Kapsul Halaman 7 dari 21 Putusan No. 147/Rid. Sus/2012/PN. P. Bun 37 Griseofulvin 125 mg PT. Indofarma 200 Tablet38 Supertetra PT.

Mutifa 5 Botol31 Cotrimoxazol Suspensi PT. Phyto Kemo Agung Farma 33 Botol32 Zinochlor Suspensi PT. Zenith Pharmaceutical 12 Botol33 Lexapram Sirup PT. Molex Ayus Pharmaceutical 8 Botol34 Fasiprim Suspensi PT. Ifars Pharmaceutical 18 BotolLaboratories35 ampicillin PT. Rama Emerald Multi Sukses 150 Kaplet36 Thiamicin 500 PT. Interbat 30 Kapsul37 Griseofulvin 125 mg PT. Indofarma 200 Tablet38 Supertetra PT. Darya Varia 78 Soft Capsule39 Mycrogynon Tablet PT.

Mutifa 5 Botol31 Cotrimoxazol PT. Phyto Kemo Agung 33 BotolSuspensi Farma32 Zinochlor Suspensi PT. Zenith Pharmaceutical 12 Botol33 Lexapram Sirup PT. Molex Ayus 8 BotolPharmaceutical34 Fasiprim Suspensi PT. Ifars Pharmaceutical 18 BotolLaboratories35 ampicillin PT. Rama Emerald Multi 150 KapletSukses36 Thiamicin 500 PT. Interbat 30 Kapsul37 Griseofulvin 125 mg PT. Indofarma 200 Tablet38 Supertetra PT. Darya Varia 78 Soft Capsule39 Mycrogynon Tablet PT.

Kotak 357 Microdiol 30 = KF Strip 958 Mixalgin Erela Strip 359 Moxigra 500 Graha Farma Strip 860 Murozal Mugi Strip 361 MycetinEar Erela Strip 2Drop62 Neo Protifed Graha Farma Strip 763 Neo K Combiphar Ampul 264 Neuralgin RX Kalbe Strip 465 Neurobion Merch Strip 6500066 Neuropyron V Harsen Strip 667 Neutropic Global Vial 1Injeksi68 Nocandis Erlimpex Strip 169 Novaflox 500 Novapharin Strip 770 Novatrim Novapharin Strip 171 Novaxicam Novapharin Strip 172 Novaxifen 400 Novapharin Strip 1073 Omedon Mutifa

Strip 1074 Omeorazole Guardian Strip 115 Ometilson Mutifa Strip 476 Opistan 500 ~Ottto Strip 8 77 Otoryl Otto Strip 478 Piroxicam INF Strip 1379 Piroxicam First Medi Strip 1080 Polofar Plus lfars Strip 481 Ponstan Pfizer Strip 582 Prix 25 Rama Strip 883 Pronicy Kalbe Strip 684 Propepsa Gratia Botol 185 Ranitidin Phapros Ampul 786 Rematat Bernofarm Strip 487 Renabetic Pratapar Strip 388 Renabetic Pratapar Strip 489 Reninacad Pratapar Strip 890 Rexanin 500 ifars Strip 891 Rhefican Bufa Aneka Strip

Strip

107

Metformin 500 mg

Indofarma

11

Strip

108

Isosorbide Dinitrat 5 mg

Indofarma

9

Strip

109

Omedom

Mutifa

Voltadex 50 Dexa Medica 9 Strip95 Yekaprim Yekaprim 5 Strip96 Zonifar Ifars 4 Stripbox97 Zelona Zenith 1 Box98 Alodan 300 Dankos 2 Box99 Selvim Ifars 2 Box100 Lanadexon Landson 2 Box101 Farmalat 19 Fahreinheit 9 Strip102 Propranolol 40 mg Kimia Farama 9 Strip103 Ambroxol 30 mg Kimia Farma 1 Box104 Loratadine 10 mg Indofarma 7 Strip105 Farmoten 25 mg Fahreinheit 7 Strip106 Renabetic 5 mg Fahreinheit 17 Strip107 Metformin 500 mg Indofarma 11 Strip108 Isosorbide Dinitrat 5 mg Indofarma 9 Strip109 Omedom Mutifa

Tbh 96 Zonifar lfars 4 Stripbox97 Zelona Zenith 1 Box98 Alodan 300 Dankos 2 Box99 Selvim Ifars 2 Box100 Lanadexon Landson 2 Box101 Farmalat 19 Fahreinheit 9 Strip102 Propranolol 40 mg Kimia Farama 9 Strip103 Ambroxol 30 mg Kimia Farma 1 Box104 Loratadine 10 mg Indofarma 7 Strip105 Farmoten 25 mg Fahreinheit 7 Strip106 Renabetic 5 mg Fahreinheit 17 Strip107 Metformin 500 mg Indofarma 11 Strip108 Isosorbide Dinitrat 5 mg Indofarma 9 Strip109 Omedom Mutifa 12 Strip110 Yasmin Bayer 4 Kotak111 Melanox

Voltadex 50 Dexa Medica 9 Strip95 Yekaprim Yekaprim 5 Strip96 Zonifar lfars 4 Stripbox97 Zelona Zenith 1 Box98 Alodan 300 Dankos 2 Box99 Selvim Ifars 2 Box100 Lanadexon Landson 2 Box101 Farmalat 19 Fahreinheit 9 Strip102 Propranolol 40 mg Kimia Farama 9 Strip103 Ambroxol 30 mg Kimia Farma 1 Box104 Loratadine 10 mg Indofarma 7 Strip105 Farmoten 25 mg Fahreinheit 7 Strip106 Renabetic 5 mg Fahreinheit 17 Strip107 Metformin 500 mg Indofarma 11 Strip108 Isosorbide Dinitrat 5 mg Indofarma 9 Strip109 Omedom Mutifa

Tbh 96 Zonifar Ifars 4 Stripbox97 Zelona Zenith 1 Box98 Alodan 300 Dankos 2 Box99 Selvim Ifars 2 Box100 Lanadexon Landson 2 Box101 Farmalat 19 Fahreinheit 9 Strip102 Propranolol 40 mg Kimia Farama 9 Strip103 Ambroxol 30 mg Kimia Farma 1 Box104 Loratadine 10 mg Indofarma 7 Strip105 Farmoten 25 mg Fahreinheit 7 Strip106 Renabetic 5 mg Fahreinheit 17 Strip107 Metformin 500 mg Indofarma 11 Strip108 Isosorbide Dinitrat 5 mg Indofarma 9 Strip109 Omedom Mutifa 12 Strip110 Yasmin Bayer 4 Kotak111 Melanox

Obat Keras172 Rifampicin 450 Kimia Farma 70 ~=Tablet Obat Keras173 Eryra Forte Rama Emerald 70 Kaplet Obat Keras174 Meloxicam Hexpharm 90 Tablet Obat Keras175 Diabit 500 Hexpharm 100 Tablet Obat Keras176 Dumocycline 250 Dumex 160 Kapsul Obat Keras177 Interhistin Interbat 100 Tablet Obat Keras Halaman 22 dari 46 Putusan Nomor 233/Pid.Sus/2018/PN Pili 178 FG Troches Meiji 50 ~Tablet ~+ Obat Keras179 Ersolon PT Erlimpex 100 Tablet Obat Keras180 Otoryl 25 Otto 200 Tablet Obat Keras181 Ometilson 4 PT Mutifa

Kaplet Obat Keras294 Inflason PT Berlico Mulia Farma 400 Kaplet Obat Keras295 Ponstan PT Pfizer 100 Tablet Obat Keras296 Neuralgin Rx PT Kalbe Farma 150 Kaplet Obat Keras297 Pyradexon PT Pyridam Farma 270 ~ Kaplet Obat Keras298 Grafachlor PT Graha Farma 230 Kaplet Obat Keras299 Suldox PT Actavis 60 Tablet Obat Keras300 Gralixa 40 mg PT Graha Farma 170 Tablet Obat Keras301 Santibi Plus PT Sanbe Farma 80 = Tablet Obat Keras302 Lapibal 500 PT Lapi Laboratories 30 Kapsul Obat Keras303 Omegtamine PT Mutifa

Obat Keras323 Suprabiotic PT Zenith Pharmaceuticals 80 Kapsul Obat Keras324 Floxifar 500 PT lfars Pharmaceutical Laboratories 100 Kaplet Obat Keras325 Scopma Plus PT lfars Pharmaceutical Laboratories 140 Kaplet Obat Keras326 Fasiprim Forte PT lfars Pharmaceutical Laboratories 70 Kaplet Obat Keras327 Fatibact Adult PT Bufa Aneka 50 ~ikaplet + Obat Keras328 Farizol 500 PT lfars Pharmaceutical Laboratories 100 Kaplet Obat Keras329 Mecobalamin PT Guardian Pharmatama 100 Kapsul Obat Keras330 Omekur PT Mutifa

Keras342 Hufadon PT Gratia Husada Farma 100 Kaplet Obat Keras343 Bidium PT Bima Mitra Farma 100 Tablet Obat Keras344 Fimestan Forte PT First Medipharma 120 Kaplet Obat Keras345 Oxicobal PT lfars Pharmaceutical Laboratories 70 Kapsul Obat Keras346 Graprima Adult PT Graha Farma 60 Tablet Obat Keras347 Flacoid 0,75 PT Yekatria Farma 150 Kaplet Obat Keras Halaman 26 dari 46 Putusan Nomor 233/Pid.Sus/2018/PN Pili 348 Alofar 100 PT lfars Pharmaceutical Laboratories 100 Kaplet Obat Keras349 Omefulvin PT Mutifa

Agung 100 Kaplet Obat Keras171 Zendalat Zenith 100 Tablet Obat Keras172 Rifampicin 450 Kimia Farma 70 ~=Tablet Obat Keras173 Eryra Forte Rama Emerald 70 Kaplet Obat Keras174 Meloxicam Hexpharm 90 = Tablet Obat Keras175 Diabit 500 Hexpharm 100 Tablet Obat Keras176 Dumocycline 250 Dumex 160 Kapsul Obat Keras177 Interhistin Interbat 100 Tablet Obat Keras178 FG Troches Meiji 50 ~=Tablet Obat Keras179 Ersolon PT Erlimpex 100 Tablet Obat Keras180 Otoryl 25 Otto 200 Tablet Obat Keras181 Ometilson 4 PT Mutifa

Mutifa 10 Strip117 Otolin PT. Kalbe Farma 3 Botol118 Pil KB Andalan PT. Harsen 20 Blister119 Pil KB Kombinasi PT. Harsen 50 Blister120 Pil KB Kombinasi PT. Triyasa 130 Blister Hal. 7 dari 38 hal, Put.No.265/PID/2015/PT.Mks Nagamas Farma121 Pil KB Kombinasi PT. Fahrenheit 380 Blister122 Folofar Plus PT. Ifars 30 Strip123 Pronicy PT. Kalbe Farma 20 Strip124 Ranitidin PT. Pertiwi Agung 20 Strip125 Reco Tetes Mata PT. Global Multi 2 Pot126 Salbutamol PT.

Mutifa 10 Strip117 Otolin PT. Kalbe Farma 3 Botol118 Pil KB Andalan PT. Harsen 20 Blister119 Pil KB Kombinasi PT. Harsen 50 Blister120 Pil KB Kombinasi PT.Triyasa 130 BlisterNagamas Farma121 Pil KB Kombinasi PT. Fahrenheit 380 Blister122 Folofar Plus PT. Ifars 30 Strip123 Pronicy PT. Kalbe Farma 20 Strip124 Ranitidin PT. Pertiwi Agung 20 Strip125 Reco Tetes Mata PT. Global Multi 2 Pot126 Salbutamol PT. Indofarma 50 Strip127 SE PKS Cream Made In China 20 Tube128 Skizon PT.

Mutifa 10 Strip117 Otolin PT. Kalbe Farma 3 Botol118 Pil KB Andalan PT. Harsen 20 Blister119 Pil KB Kombinasi PT. Harsen 50 Blister120 Pil KB Kombinasi PT. Triyasa 130 BlisterNagamas Farma121 Pil KB Kombinasi PT. Fahrenheit 380 Blister122 Folofar Plus PT. Ifars 30 Strip123 Pronicy PT. Kalbe Farma 20 Strip124 Ranitidin PT. Pertiwi Agung 20 Strip125 Reco Tetes Mata PT. Global Multi 2 Pot126 Salbutamol PT. Indofarma 50 Strip127 SE PKS Cream Made In China 20 Tube128 Skizon PT.

Mutifa 10 Strip117 Otolin PT. Kalbe Farma 3 Botol118 Pil KB Andalan PT. Harsen 20 Blister119 Pil KB Kombinasi PT. Harsen 50 Blister120 Pil KB Kombinasi PT.Triyasa 130 BlisterNagamas Farma121 Pil KB Kombinasi PT. Fahrenheit 380 Blister122 Folofar Plus PT. lIfars 30 Strip123 Pronicy PT. Kalbe Farma 20 Strip124 Ranitidin PT. Pertiwi Agung 20 Strip125 Reco Tetes Mata PT. Global Multi 2 Pot126 Salbutamol PT. Indofarma 50 Strip127 SF PKS Cream Made In China 20 Tube128 Skizon PT.

22

Ketoconazole 200mg

Novapharin Pharm Inds

50

Tablet

23

Opistan 500

PT Pertiwi Agung

40

Tablet

24

Omegtamine

PT Mutifa

500mg PT Mersifarma TM 120 Tablet14 Allopurinol Novapharin Pharm Inds 170 Tablet15 Ampicilin Novapharin Pharm Inds 80 Tablet16 Rhemafar 4 mg PT Ifar 60 Tablet17 Farmalat 10 PT Pratapa Nirmala 80 Tablet18 FG Troces Meiji PT Meiji Indonesian 53 Tablet19 Ciprofloxacin 500mg PT Promedrahardjo FI 20 Tablet20 Kalmethasone 0,5mg PT Kalbe Farma 230 Tablet21 Mikrogynon PT Bayer Indonesia 6 Blister22 Ketoconazole 200mg Novapharin Pharm Inds 50 Tablet23 Opistan 500 PT Pertiwi Agung 40 Tablet24 Omegtamine PT Mutifa

Ketoconazole 200mg Novapharin Pharm Inds 50 Tablet23 Opistan 500 PT Pertiwi Agung 40 Tablet24 Omegtamine PT Mutifa 130 Tablet25 Ranitidine 150mg PT Dexa Medica 120 Tablet26 Inflason PT Dexa Medica 130 Tablet27 Dextrem Plus PT Sampharindo Perdana (20 Tablet28 Griseofulvin 500 mg PT Samco Farma 40 Tablet29 AAmbrokso 30 mg PT Indofarma 50 Tablet30 Grathazon Kaplet PT Graha Farma 80 Kaplet31 Teosal Tablet PT Dexa Madica 40 Tablet32 Piralen Tablet PT Otto 60 Tablet33 Amlodipine Besylate 10/PT Promedrahardjo

Novapharin Pharm170TabletInds15 Ampicilin Novapharin Pharmjs0 TabletInds16 Rhemafar 4 mg PT Ifar 60 Tablet Halaman 18 dari 23 Putusan Nomor 111/Pid.Sus/2018/PN Bjb 17 Farmalat 10 PT Pratapa Nirmala 80 Tablet18 FG Troces Meiji PT Meiji Indonesian (53 /Tablet19 Ciprofloxacin 500mg PT Promedrahardjo FI 20 Tablet20 Kalmethasone 0,5mgPT Kalbe Farma 230 Tablet21 Mikrogynon PT Bayer Indonesia 6 Blister22 Ketoconazole 200mgNovapharin Pharm50 TabletInds25 Opistan 500 PT Pertiwi Agung 40 Tablet24 Omegtamine PT Mutifa

Ketoconazole 200mg Novapharin Pharm Inds 50 Tablet23 Opistan 500 PT Pertiwi Agung 40 Tablet24 Omegtamine PT Mutifa 130 Tablet25 Ranitidine 150mg PT Dexa Medica 120 Tablet26 Inflason PT Dexa Medica 130 Tablet27 Dextrem Plus PT Sampharindo Perdana 20 Tablet28 Griseofulvin 500 mg PT Samco Farma 40 Tablet29 AAmbrokso 30 mg PT Indofarma 50 Tablet30 Grathazon Kaplet PT Graha Farma 80 (Kaplet31 Teosal Tablet PT Dexa Madica 40 Tablet32 Piralen Tablet PT Otto 60 Tablet33 Amlodipine Besylate 10/PT Promedrahardjo

Mutifa 200 Kaplet Obat Keras Daftar G;

Molex Ayus Pharmaceutical 90 Tablet Obat Keras Daftar G;

Mutifa 400 Tablet165 Daftar G100 Obat KerasRexavin 125 PT. lfars166 Kaplet Daftar G167 Ranitidine 150 PT. Hexpharm 200 Tablet Obat Keras Halaman 9 dari 79 Putusan Pidana Nomor 147/Pid.Sus/2019/PN Kgn Jaya Daftar G. Obat KerasRifampicin 600 mg PT. Indofarma 100 Tablet168 Daftar G100 Obat KerasRoverton PT. lfars169 Kaplet Daftar GPT. Rama 190 Obat KerasRamavex170 Emerald Kaplet Daftar GPT.

Molex AyusObat KerasMolacort 0.5 mg Pharmaceutic 90 TabletDaftar G246 alPT Zenith Obat KerasAlvita 70 Kaplet247 Pharmacetical Daftar GObat KerasOmefulvin PT Mutifa 80 Tablet248 Daftar GPT Yekatria Obat KerasNiprocor 200 Tablet249 Farma Daftar G244 Obat KerasNeuralgin Rx PT Kalbe Farma250 Kaplet Daftar G251 Flasicox 15 PT lfars 100 Obat Keras Halaman 13 dari 79 Putusan Pidana Nomor 147/Pid.Sus/2019/PN Kgn Kaplet Daftar GPT.

Molex Ayus Obat Keras246 Molacort 0.5 mg 90 TabletPharmaceutical Daftar GPT Zenith Obat Keras247 Alvita 70 KapletPharmacetical Daftar G248 Omefulvin PT Mutifa 80 Tablet Obat Keras Halaman 32 dari 79 Putusan Pidana Nomor 147/Pid.Sus/2019/PN Kgn Daftar G PT Yekatria Obat Keras249 Niprocor 200 TabletFarma Daftar G244 Obat Keras250 Neuralgin Rx PT Kalbe FarmaKaplet Daftar G100 Obat Keras251 Flasicox 15 PT lfarsKaplet Daftar GPT.

Molex Ayus Obat Keras246 Molacort 0.5 mg 90 TabletPharmaceutical Daftar G247 Alvita PT Zenith 70 Kaplet Obat Keras Halaman 50 dari 79 Putusan Pidana Nomor 147/Pid.Sus/2019/PN Kgn Pharmacetical Daftar GObat Keras248 Omefulvin PT Mutifa 80 TabletDaftar GPT Yekatria Obat Keras249 Niprocor 200 TabletFarma Daftar G244 Obat Keras250 Neuralgin Rx PT Kalbe FarmaKaplet Daftar G100 Obat Keras251 Flasicox 15 PT lfarsKaplet Daftar GPT.

Mutifa 400 Tablet165 Daftar G100 Obat KerasRexavin 125 PT. lfars166 Kaplet Daftar Ges PT. Hexpharm Obat KerasRanitidine 150 200 Tablet167 Jaya Daftar G. Obat KerasRifampicin 600 mg PT. Indofarma 100 Tablet168 Daftar G100 Obat KerasRoverton PT. lfars169 Kaplet Daftar GPT. Rama 190 Obat KerasRamavex170 Emerald Kaplet Daftar G171 Ramoxyl 500 PT.

Pharos 6 tube 24.000 144.000 GDaftar82 Neuropyron Harsen 10 tab 900 9.000 .100 Daftar83 Neuralgin Rx Kalbe 880 88.000tab G10 Daftar84 NeurobiontInj Merck 20.000 200.000amp G; Daftar85 Nisagon Cr Ifars 3 tube 15.000 45.000 86 Novabiotic Novapharin 20 tab 750 15.000 Daftar Halaman 5 dari 42 Putusan Nomor 57/Pid.Sus/2020/PN Mkm G 100 Daftar87 Novachlor Novapharin 100 10.000tab G12 Daftar88 Novagyl syrup Novapharin 12.000 144.000botol G400 Daftar89 Novamox Novapharin 1.200 480.000tab GDaftar90 Omegesic Mutifa

Putusan Nomor 57/Pid.Sus/2020/PN Mkm G Daftar81 Nebacetin Pharos 6 tube 24.000 144.000 6Daftar82 Neuropyron Harsen 10 tab 900 9.000 6100 Daftar83 Neuralgin Rx Kalbe 880 88.000tab G10 Daftar84 NeurobionInj Merck 20.000 200.000amp G; Daftar85 Nisagon Cr Ifars 3 tube 15.000 45.000 6 Daftar86 Novabiotic Novapharin 20 tab 750 15.000 100 Daftar87 Novachlor Novapharin 100 10.000tab G12 Daftar88 Novagyl syrup Novapharin 12.000 144.000botol G400 Daftar89 Novamox Novapharin 1.200 480.000tab GDaftar90 Omegesic Mutifa

Daftar80 Mycoral Kalbe 5.200 260.000tab G6 Daftar81 Nebacetin Pharos 24.000 144.000tube G10 Daftar82 Neuropyron Harsen 900 9.000tab G100 Daftar83 Neuralgin Rx Kalbe 880 88.000tab G10 Daftar84 NeurobionInj Merck 20.000 200.000amp G3 Daftar85 Nisagon Cr Ifars 15.000 45.000tube G 20 Daftar86 Novabiotic Novapharin 750 15.000tab G100 Daftar87 Novachlor Novapharin 100 10.000tab G12 Daftar88 Novagyl syrup Novapharin 12.000 144.000botol G400 Daftar89 Novamox Novapharin 1.200 480.000tab G80 Daftar90 Omegesic Mutifa

Pharos 6 tube 24.000 144.000 EDaftar82 Neuropyron Harsen 10 tab 900 9.000 G100 Daftar83 Neuralgin Rx Kalbe 880 88.000tab G10 Daftar84 NeurobionInj Merck 20.000 200.000amp G; Daftar85 Nisagon Cr Ifars 3 tube 15.000 45.000 G Daftar86 Novabiotic Novapharin 20 tab 750 15.000 87 Novachlor Novapharin 100 100 10.000 Daftar Halaman 33 dari 42 Putusan Nomor 57/Pid.Sus/2020/PN Mkm tab G12 Daftar88 Novagyl syrup Novapharin 12.000 144.000botol G400 Daftar89 Novamox Novapharin 1.200 480.000tab GDaftar90 Omegesic Mutifa

Pharos 6 tube 24.000 144.000 GDaftar82 Neuropyron Harsen 10 tab 900 9.000 .100 Daftar83 Neuralgin Rx Kalbe 880 88.000tab G10 Daftar84 NeurobiontInj Merck 20.000 200.000amp G; Daftar85 Nisagon Cr Ifars 3 tube 15.000 45.000 86 Novabiotic Novapharin 20 tab 750 15.000 Daftar Halaman 39 dari 42 Putusan Nomor 57/Pid.Sus/2020/PN Mkm G 100 Daftar87 Novachlor Novapharin 100 10.000tab G12 Daftar88 Novagyl syrup Novapharin 12.000 144.000botol G400 Daftar89 Novamox Novapharin 1.200 480.000tab GDaftar90 Omegesic Mutifa

Omestan 500 Mutifa 1 box35. Etamidon Errita 1 box36. Antalgin Mutida 1 botol37. Rhemakap Gratia 1 botol38. Antalgin Zenith 1 botol39. Bimadex 0,75 Bina Mitra Farma 1 botol40. Ambroxol Syrup Indofarma 1 botol41. Erlamycetin Tetes Telinga Erela 3 botol42. Microgynon Schering 1 blister43. Andalan Pil KB Harsen 1 box44. Erlamycetin Erla 1 tube45. Decoderm 3 Merck 1 tube46. Bioplacenton Kalbe 1 tube47. Bufacort N Bufa Aneka 2 tube48. Chloramfecort H Kimia Farma 1 tube49.

No. 888K/PID.SUS/2010 28 Mefina 500 Sanbe 1 box29 Ottoprim Otto 1 boxPharmaceutical30 Super Tetra Darya Varia 1 box31 Neuralgin RX Kalbe Farme 1 box32 Tibigon Progestin Hexapharm 1 box33 Depo Progestin Hersen 1 box34 Omestan 500 Mutifa 1 box35 Etamidon Errita 1 box36 Antalgin Mutida 1 botol37 Rhemakap Gratia 1 botol38 Antalgin Zenith 1 botol39 Bimadex 0,75 Bina Mitra Farma 1 botol40 Ambroxol Syrup Indofarma 1 botol41 Erlammycetin tetes telinga Erela 1 botol42 Microgynon Schering 1 blister43 Andalan

Mutifa 720 Kaptab Obat Keras;

Mutifa b22 Omekur PT. Mutifa 175 ~=Tablet Obat Keras23 Potaflam 50 100 Kaple Obat KerasPT. Berlico '24 Piroxicam PT. Novapharin 530 = Tablet Obat Keras25 Ponstan PT. Pfizer 50 Tablet Obat Keras26 Pronicy 210 Kaple Obat KerasPT. Kalbe Farma ;27 Pronto 40 Kaple Obat KerasPT. Zenith ,28 Prodiabet PT. Bernofarm 30 Tablet Obat Keras29 Ponstelax 500 40 Kaple Obat KerasPT. Combiphar ,30 Prostanac PT.

Mutifa 720 + Kaptab ; ObatKeras22 Omekur 175 Tablet ObatPT. Mutifa espa23 Potaflam 50 ; 100 Kaplet ObatPT. Berlico Keras24 Piroxicam PT. 530 Tablet ObatNovapharin Keras25 Ponstan PT. Pfizer 50 Tablet ObatKeras26 Pronicy PT. Kalbe 210 Kaplet ObatFarma Keras27 Pronto PT. Zenith 40 Kaplet ObatKeras28 Prodiabet PT. 30 Tablet ObatBernofarm Keras29 Ponstelax 500 PT. 40 Kaplet ObatCombiphar Keras30 Prostanac PT.

Mutifa 22 Omekur ; 175 Tablet ObatPT. Mutifa Keras23 Potaflam 50 ; 100 Kaplet ObatPT. Berlico Karas24 Piroxicam PT. 530 Tablet ObatNovapharin Keras25 Ponstan PT. Pfizer 50 Tablet ObatKeras26 Pronicy PT. Kalbe 210 Kaplet ObatFarma Keras27 Pronto PT. Zenith 40 Kaplet ObatKeras28 Prodiabet PT. 30 Tablet ObatBernofarm Keras29 Ponstelax 500 PT. 40 Kaplet ObatCombiphar Keras30 Prostanac PT.

Mutifa 720 Kaptab ObatKeras22 Omekur PT. Mutifa 175 Tablet ObatKeras23 Potaflam 50 PT. Berlico 100 Kaplet ObatKeras24 Piroxicam PT. 530 Tablet ObatNovapharin Keras25 Ponstan PT. Pfizer 50 Tablet ObatKeras26 Pronicy PT. Kalbe 210 Kaplet ObatFarma Keras27 Pronto PT. Zenith 40 Kaplet ObatKeras28 Prodiabet PT. 30 Tablet ObatBernofarm Keras29 Ponstelax 500 PT. 40 Kaplet ObatCombiphar Keras30 Prostanac PT.

Anak Pertama, MUTIFA MAFRIANTI Binti SUPANGAT, Jeniskelamin Perempuan, Lahir tanggal 6 Mei 2000 ( 19 Tahun ),pendidikan Kuliah di Universitas Muhammadiayah Malang semestr III.Halaman 2 dari 77 halaman Putusan Nomor 520/Padt.G/2019/PA.Rgt2. Anak Kedua, Xxx, Jenis Kelamin Perempuan, Lahir tanggal 24 Juli2002 ( 17 Tahun ), pendidikan SMK kelas III di Pekanbaru.3. Anak Ketiga, Xxx, Jenis Kelamin lakilaki, Lahir tanggal 17Oktober 2004 ( 15 Tahun ), pendidikan SMK kelas di Belilas IndragiriHulu.4.

Anak Pertama, MUTIFA MAFRIANTI Binti SUPANGAT, Jeniskelamin Perempuan, Lahir tanggal 6 Mei 2000 ( 19 Tahun ),pendidikan Kuliah di Universitas Muhammadiayah Malang semestr III.2. Anak Kedua, Xxx, Jenis Kelamin Perempuan, Lahir tanggal 24 Juli2002 (17 Tahun ), pendidikan SMK kelas III di Pekanbaru.3. Anak Ketiga, Xxx, Jenis Kelamin lakilaki, Lahir tanggal 17Oktober 2004 ( 15 Tahun ), pendidikan SMK kelas di Belilas IndragiriHulu.4.

Anak pertama MUTIFA MEFRIANTI Binti SUPANGAT jeniskelamin perempuan. Lahir tanggal 6 Mei 2000 (19 Tahun) pendidikankuliah di Universitas Muhamadiyah malang Semester III.2. Anak Kedua Xxx, jenis kelamin Perempuan, Lahir Tanggal 24 Juli2002 (17 tahun) Pendidikan SMK Kelas III Di pekanbaru.3. Anak ketiga Xxx, jenis kelamin Lakilaki, lahir tanggal 17 Oktober2004 (15 Tahun) SMK kelas di belilas Indragiri Hulu4.

Fotokopi bukti transfer biaya pendidikan ke Mutifa Mafriyantimelalui Bank Rakyat Indonesia, Bukti surat tersebut telah diberimeterai cukup, telah dinazegelen Pos dan telah dicocokkan denganaslinya yang ternyata sesuai (Bukti T.1) ;2. Fotokopi bukti transfer melalui Bank Rakyat Indonesia, Bukti surattersebut telah diberi meterai cukup, telah dinazegelen Pos dan telahdicocokkan dengan aslinya yang ternyata sesuai (Bukti T.2) ;3.

Foto copy sesuai asli, bukti transper uang kepada anak Penggugat danTergugat, Mutifa Mafriyanti dengan Nomor Rekening 551901014231538Bank BRI atas nama Mutifa Mafriyanti, yang dilakukan Tergugat sebagaiayah, telah diberi materai 6.000 (P 1) ;Bukti ini menjelaskan kalau Tergugat menjalankan tugas nya sebagaiseorang ayah, menafkahi membiayai uang kuliah anak Penggugat danTergugat ;2.

Botol185 Miratadin PT Sampharindo Perdana 1 Botol186 Holimicetine PT Holi Pharma 1 Botol187 Novachlor PT Novapharin 1 Botol188 Pritamox PT Molex Ayus 3 Botol189 Hufabethamin PT Gratia Husada Farma 2 Botol190 Solpenox PT Solas 2 Botol191 Reco Tetes Telinga PT Global Multi 5 Cair192 Alletrol PT Erela 3 Cair193 Cendo Xitrol PT Cendo 1 Cair194 Trinordiol 28 PT Sunthi Sepuri 9 blister@28's195 Molacort 0,75 PT Molex Ayus 120 Tablet196 Megasonum 0,75 PT Mega Esa Farma 70 Kaplet197 Metronidazol 500 PT Mutifa

Holimicetine PT Holi Pharma 1 Botol187 Novachlor PT Novapharin 1 Botol Halaman 37 dari 38 Putusan Nomor 7/Pid.Sus/2017/PN Kgn 188 Pritamox PT Molex Ayus 3 Botol189 Hufabethamin PT Gratia Husada Farma 2 Botol190 Solpenox PT Solas 2 Botol191 Reco Tetes Telinga PT Global Multi 5 Cair192 Alletrol PT Erela 3 Cair193 Cendo Xitrol PT Cendo 1 Cair194 Trinordiol 28 PT Sunthi Sepuri 9 blister@28's195 Molacort 0,75 PT Molex Ayus 120 Tablet196 Megasonum 0,75 PT Mega Esa Farma 70 Kaplet197 Metronidazol 500 PT Mutifa

Mutifa Medan Ind 60 Tablet31 Inerson 15 g DKL8817605230A1 PT. Interbat Jatim Ind 1 KotakSalep32 Bioplacenton DKL7211638828A1 PT. Kalbe Farma Tbk 3 Kotak Halaman 3 dari 9 hal. Put. Nomor 213 K/Pid.Sus/2021 15g Bekasi Ind33 AcifarCream 5 DKL9909209929A1 PT. Ifars Kotakg PharmaceuticalLaboratoriesKaranganyar34 Alofar 100 DKL9709207004A1 PT. lfars StripPharmaceuticalLaboratoriesKaranganyar35 Yusimox Syrup DKL9909212438A1 PT.

Ifars btl 950 Lokev Ifars Strip 1551 Loratadine Pyridam Strip 25Mebhydrolin52 Napadisilate strip 4053 Mediklin gel Surya tube 1454 Mefenamic Acid strip 12055 Metformin Hexapharm Strip 40Methylprednisolon56 /e strip 2057 Meloxicam Strip 1058 Mexon strip 5059 Micoral Strip 1560 Microdial KF bungkus 3261 Mixalgin Erella Strip 4062 Mycetin tts telinga Erella strip 563 Mycroginon Bayer strip 1564 Neuralgin Kalbe F Strip 3065 Neuvopyron V Harsen Strip 2066 Nizoral strip 667 Omeprazol Strip 8468 Omeroxol Mutifa

25Mebhydrolin52 Napadisilate strip 4053 Mediklin gel Surya tube 1454 Mefenamic Acid Strip 120Hexaphar55 Metformin m Strip 40Methylprednisolon56 e strip 2057 Meloxicam Strip 1058 Mexon strip 5059 Micoral Strip 1560 Microdial KF bungkus 3261 Mixalgin Erella Strip 4062 Mycetin tts telinga Erella strip 5 Halaman 23 dari 105 Putusan Nomor 198/Pid.Sus/2020/PN.Rgt 63 Mycroginon Bayer strip 1564 Neuralgin Kalbe F Strip 3065 Neuvopyron V Harsen Strip 2066 Nizoral strip 667 Omeprazol Strip 8468 Omeroxol Mutifa

25Mebhydrolin52 Napadisilate strip 4053 Mediklin gel Surya tube 1454 Mefenamic Acid strip 120Hexaphar55 Metformin m Strip 4056 Methylprednisolon Strip 20 Halaman 35 dari 105 Putusan Nomor 198/Pid.Sus/2020/PN.Rgt e 57 Meloxicam Strip 1058 Mexon strip 5059 Micoral Strip 1560 Microdial KF bungkus 3261 Mixalgin Erella Strip 4062 Mycetin tts telinga Erella strip 563 Mycroginon Bayer strip 1564 Neuralgin Kalbe F Strip 3065 Neuvopyron V Harsen Strip 2066 Nizoral strip 667 Omeprazol Strip 8468 Omeroxol Mutifa

Ifars btl 950 Lokev Ifars Strip 1551 Loratadine Pyridam Strip 25Mebhydrolin52 Napadisilate strip 4053 Mediklin gel Surya tube 1454 Mefenamic Acid strip 120Hexaphar55 Metformin m Strip 40Methylprednisolon56 e strip 2057 Meloxicam Strip 1058 Mexon strip 5059 Micoral Strip 1560 Microdial KF bungkus 3261 Mixalgin Erella Strip 4062 Mycetin tts telinga Erella strip 563 Mycroginon Bayer strip 1564 Neuralgin Kalbe F Strip 3065 Neuvopyron V Harsen Strip 2066 Nizoral strip 667 Omeprazol Strip 8468 Omeroxol Mutifa

25Mebhydrolin52 Napadisilate strip 4053 Mediklin gel Surya tube 1454 Mefenamic Acid strip 12055 Metformin Hexapharm Strip 40Methylprednisolon56 /e strip 2057 Meloxicam Strip 1058 Mexon strip 5059 Micoral Strip 1560 Microdial KF bungkus 3261 Mixalgin Erella Strip 4062 Mycetin tts telinga Erella strip 5 Halaman 93 dari 105 Putusan Nomor 198/Pid.Sus/2020/PN.Rgt 63 Mycroginon Bayer strip 1564 Neuralgin Kalbe F Strip 3065 Neuvopyron V Harsen Strip 2066 Nizoral strip 667 Omeprazol Strip 8468 Omeroxol Mutifa

MUTIFA AUREL NOVIANA Binti MARJOHAN Lahir pada Tanggal 27November 2012;5.4. MAHIRA BILQIS DESRIANA Binti MARJOHAN Lahir pada tanggal 22Desember 2014;5.5. MUHAMMAD HAFIS FATHAN Bin MARJOHAN Lahir 20 Mei 2017;Yang Saat ini tinggal bersama Pemohon;. Bahwa di dalam menjalani hubungan rumah tangga tersebut antara Pemohondan Termohon pada awalnya telah hidup rukun layaknya pasangan suami istri,walaupun terkadang timbul perselisihan/percekcokan namun dapatdiselesaikan;.

7038 Metoclopramide First M Tablet 10039 Mexon Sampahrindo Tablet 21040 Muzoral Cream Mugi Tube 1041 Muzoral Tablet Mugi Tablet 5042 Natrium Diclofenak 50 mg Novell Tablet 5043 Natrium Diclofenak KF Tablet 4044 Natrium Diclofenak Phapros Tablet 5045 Neuralgin RX Kalbe Tablet 7046 Neuromec Mecosin Tablet 7047 Neuropyron V Harsen Tablet 9048 Nizoral Jansen Tablet 2849 Novachlor Novapharin Tablet 10050 Novadex Novapharin Tablet 300 51 Novadium Novapharin Tablet 16052 Omemox 500 Mutifa

Tablet 2853 Omeprazole 20 mg KF Tablet 2054 Omestan 500 Mutifa Mutifa Tablet 3055 Oxytetracyclin Salep Kulit 3% KF Tube 2256 Pehacain Phapros Ampul 2057 Penicillin V Prafa Tablet 8058 Pil KB 1 Kombinasi Triyasa Strip 42959 Pronicy Kalbe Tablet 42060 Pyradexon Pyrida Tablet 9061 Renadinac 50 Pratapa N Tablet 14062 Rifampicin 450 mg Indo Farma Tablet 7063 Sammoxin Syr Samco Botol 364 Solpenox Syr Solas Botol 465 Spiramycin 1,5 Novell Box 5066 Supertetra Darya Varia Kaplet 16267 Teosal

Obat Keras106 Piroxicam 20 mg PT Kimia Farma 210 Tablet Obat Keras107 Pondex Forte PT Dexa Medica 99 Kaplet Obat Keras108 Pronicy 4 PT Kalbe Farma 120 Kaplet Obat Keras109 Pirocam 20 PT Dexa Medica 30 Capsul Obat Keras110 Pronam PT Harsen 60 Kaplet Obat Keras111 Ponstan 500 PT Pfizer 98 Tablet Obat Keras112 Piroxicam 10 mg PT Trifa Raya Laboratories 90 Tablet Obat Keras113 Primadex Forte PT Dexa Medica 160 Kaplet Obat Keras114 Polofar Plus PT Ifars 150 Kaplet Obat Keras115 Omegtamine PT Mutifa

Kaplet Obat Keras106 Piroxicam 20 mg PT Kimia Farma 210 Tablet Obat Keras107 Pondex Forte PT Dexa Medica 99 Kaplet Obat Keras108 Pronicy 4 PT Kalbe Farma 120 Kaplet Obat Keras109 Pirocam 20 PT Dexa Medica 30 Capsul Obat Keras110 Pronam PT Harsen 60 Kaplet Obat Keras111 Ponstan 500 PT Pfizer 98 Tablet Obat Keras112 Piroxicam 10 mg PT Trifa Raya Laboratories 90 Tablet Obat Keras113 Primadex Forte PT Dexa Medica 160 Kaplet Obat Keras114 Polofar Plus PT lfars 150 Kaplet Obat Keras115 Omegtamine PT Mutifa

210 Tablet Obat Keras107 Pondex Forte PT Dexa Medica 99 Kaplet Obat Keras108 Pronicy 4 PT Kalbe Farma 120 Kaplet Obat Keras109 Pirocam 20 PT Dexa Medica 30 Capsul Obat Keras110 Pronam PT Harsen 60 Kaplet Obat Keras111 Ponstan 500 PT Pfizer 98 Tablet Obat Keras112 Piroxicam 10 mg PT Trifa Raya Laboratories 90 Tablet Obat Keras Halaman 23 Putusan Nomor : 301/Pid.Sus/2015/PN.Rta 113 Primadex Forte PT Dexa Medica 160 Kaplet Obat Keras114 Polofar Plus PT lfars 150 Kaplet Obat Keras115 Omegtamine PT Mutifa

M E N G A D I L I

1. Menyatakan Tergugat telah dipanggil secara resmi dan patut untuk menghadap ke persidangan, tidak hadir;

2. Mengabulkan gugatan Penggugat dengan verstek;

3. Menjatuhkan talak satu bain sughra Tergugat (Endra Efendi bin Basri Tanjung) terhadap Penggugat (Mutifa Rini binti Edi Warman);

4. Memerintahkan Panitera Pengadilan Agama Bengkalis untuk mengirimkan salinan