XYZ SDN BHD

CLAIM FORM

Name : _____________________________NRIC : _____________________________

Designation : _____________________________Tel No. : _____________________________ Month

Date Details of Expenses Receipt No. Petrol Tol Meals Allowance Entertaiment Exp Stationery Other Expenses
A B C D E F

Total

TOTAL CLAIM (A+B+C+D+E+F)

Requested By Endorsed By Approved By LESS : ADVANCE TAKEN

Signature DUE TO GOURMET OFFSHORE

Name

Date

NOTE : 1. Refund or surplus from advance taken should be submitted together with this claim.
2. All staff claims must be submitted together with supporting bills and receipts.