TRAVEL EXPENSES AUTHORISATION

NAME : DEPT :
PURPOSE OF TRIP : DESTINATION
ACTUAL
DEPARTURE PLAN RETURN PLAN TRAVELS DEPARTURE PLAN RETURN PLAN TRAVELS
DATE TIME DATE TIME DAYS DATE TIME DATE TIME DAYS
ARRANGED BY COMPANY TICKET HOTEL
( YES / NO )
`
EXPENSE TYPE PLANED EXPENSES ACTUAL EXPENSES
In Rp. C!!"n#$ V%&" 'n Rp. C!!"n#$ V%&" TOTAL
MEAL ALLO(ANCE
TRANSPORT ALLO(ANCE
AIRPORT TAX
TAXI ) FROM AND TO AIRPORT SOETA
HOTEL
TICKET PESA(AT / K.A / BUS
OTHER
ALLO(ANCE
TOTAL EXPENSES
ADVANCE PAYMENT ( *n&$ +*! ",#"p-'*n%& #%." ) : REIMBURSEMENT ( Rp. )
REMARKS REMARKS :
NAME DATE SIGNATURE NAME DATE SIGNATURE
PREPARED BY
Rp -
APPROVED BY ( M%n%/"! )
APPROVED BY ( DIR )