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The Detail Sheet of Claim: 1 28-Sep-15 IDR 200,000

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The detail sheet of claim

Project Name
PO NO.

IPTV TELKOM

Subcontractor Name
Claimed by
Periods of claim

CAD Solusindo
Muh. Khairul Akbar / 6469000453
September-2015

NO.

Long-distance transportation expense


TRIP
VEHICLE

DATE

CURRENCY

AMOUNT

TOTAL

NO.

Intra-city transportation expense


TRIP
VEHICLE

DATE

CURRENCY

AMOUNT

TOTAL

NO

DATE - check in time

DATE- check out time

accommodation expense
Nation or District

PRICE

CURRENCY

TOTAL

NO

visa expense
CURRENCY

expenditure date

AMOUNT

TOTAL

NO
1

expenditure date
28-Sep-15

communication expense
CURRENCY
IDR

TOTAL

NO

remark

AMOUNT
200,000

remark

200,000
other expense
CURRENCY

expenditure date

AMOUNT

description

TOTAL
TOTAL AMOUNT ALL EXPENSES

200,000.00

Signed by,

Name of Employee
Muh. Khairul Akbar
Note :
a
b
c
d

Team Leader
Muh Hapizal Khattab

please provide the relative supporting when submit the reimbursement


please indicate only one person's expense on each sheet as possible
Reimbursement's periods: once claim each month, and should be submit maximal in 2 months
Do not combine a group of vouchers into a sum one, please fill in the blank with each voucher

Project Manager
Wang Hong Kun

remark

remark

AMOUNT

remark

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