Doc. No.

:GA-SA-F07
Rev. No. : 4
ZAIDUN-LEENG SDN BHD Rev. Date : 8-11-18

Out-of-Pocket Expenses Reimbursement Form

Staff No. : Name : Division / Dept. : CE ME EE IN ST GA ICT (Please circle)

Project Name : Project

No. &
Location :

1 2 3 4 5 6 7 8 9 10 11 12

Travelled Car For

Miscellaneous Expenses: Amount Total Amount Grand Total Remarks Office
Total Total for SST
(RM0.60/KM) (e.g Meal, Hotel, Toll, without / (included Due for Please State Reasons for this Site Visit Use.
No. Date Travelled Column 4 Amount
, Motorbike Parking etc.) before SST SST) Columns 5 & 9
From To (KM) (RM) (RM)
(RM0.13/KM) (RM) (RM) (RM)
* Please State Here The If Rec.
Type of Expenses

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

- - -

Sub-Total : - - - - -

* Subject to the latest prevailing mileage claims rates from time to time.

Grand Total
(RM) : Claimed By : …………………………….……… Approved By : …………………………….……………
Signature DIC / Managing Director

Checked By : …………………………….…………… Verified By : …………………………….……………

Page No. : of Admin & A/C Dept. General Manager-Finance & Admin.