Female Cancer Programme

MFS "See and Treat"

National Secretariat
Departemen IKK – FKUI, JL. Pegangsaan Timur No. 16 - Jakarta 10320 - Indonesia
Phone +62 21 319 04862 - Fax +62 21 319 04862 e-mail : fcp.st.indonesia@yahoo.com

TRANSPORT FORM
Taxi/Bus/Others

Date :
Name of Travellers :
Address :
Purpose :
From :
To :
Total Amount Received :

Travellers, Acknowledge by,

(………………………..) (……………………………)

The Form is Used if External Supporting Document Cannot be Submitted

Female Cancer Programme

MFS "See and Treat"
National Secretariat
Departemen IKK – FKUI, JL. Pegangsaan Timur No. 16 - Jakarta 10320 - Indonesia
Phone +62 21 319 04862 - Fax +62 21 319 04862 e-mail : fcp.st.indonesia@yahoo.com

TRANSPORT FORM
Taxi/Bus

Date :
Name of Travellers :
Address :
Purpose :
From :
To :
Total Amount Received :

Travellers, Acknowledge by,

(………………………..) (……………………………)

The Form is Used if External Supporting Document Cannot be Submitted

 Female Cancer Programme
MFS "See and Treat"
National Secretariat
Departemen IKK – FKUI, JL. Pegangsaan Timur No. 16 - Jakarta 10320 - Indonesia
Phone +62 21 319 04862 - Fax +62 21 319 04862 e-mail : s_t07nas@yahoo.com

TRANSPORT FORM
Taxi/Bus/Others

Date : (1)
Name of Travellers : (2)
Address : (3)
Purpose : (4)
From : (5)
To : (6)
Total Amount Received : (7)

Travellers, Acknowledge by,

(8) '(9)

(………………………..) (……………………………)

The Form is Used if External Supporting Document Cannot be Submitted

Penjelasan Pengisian :
(1) Diisi berdasarkan tanggal terjadinya transaksi pengeluaran biaya transport.
(2) Diisi berdasarkan nama dari orang yang melakukan perjalanan.
(3) Diisi dengan alamat dari orang yang melakukan perjalanan.
(4) Diisi dengan tujuan dari dilakukannya perjalanan.
(5) Diisi berdasarkan tempat keberangkatan perjalanan tersebut.
(6) Diisi berdasarkan tempat tujuan dari perjalan tersebut.
(7) Diisi berdasarkan nominal uang yang dikeluarkan.
(8) Diisi dengan tanda tangan orang yang melakukan perjalanan.
(9) Diisi dengan tanda tangan finance manager.
 Female Cancer Programme
MFS "See and Treat"
National Secretariat
Departemen IKK – FKUI, JL. Pegangsaan Timur No. 16 - Jakarta 10320 - Indonesia
Phone +62 21 319 04862 - Fax +62 21 319 04862 e-mail : s_t07nas@yahoo.com

TRANSPORT FORM
Taxi/Bus/Others

Date : April 15, 2007

Name of Travellers : Ms.Dini
Address : Salemba No.6
Purpose : Took Care Bank Account
From : Cikini
To : Salemba
Total Amount Received : Rp 6,000

Travellers, Acknowledge by,

( Dini ) (Siske Annisa)

The Form is Used if External Supporting Document Cannot be Submitted