PT Bank Syariah “X”
Laporan Sumber dan Penggunaan Dana Kebajikan
Per 31 Desember 20XX
Sumber Dana
Kebajikan
     Infak Zakat dari dalam bank syariah                                             xxx
Sedekah                                                                                          xxx
Hasil pengelolaan wakaf                                                                xxx
Pengembalian dana kebajikan produktif                                        xxx
Denda                                                                                             xxx
Pendapatan nonhalal                                                                      xxx
Jumlah Sumber
Dana Kebajikan                                                                            xxx
Penggunaan Dana
Kebajikan                                                          
Dana kebajikan produktif                                                             (xxx)
Sumbangan                                                                                    (xxx)
Penggunaan lainnya untuk kepentingan
umum                             (xxx)
Jumlah
Penggunaan Dana Kebajikan                                                                   (xxx)
Kenaikan
(penurunan) dana kebajikan                                                                 xxx
Saldo awal dana
kebajikan                                                                                      xxx
Saldo akhir dana
kebajikan                                                                                     xxx