Document No.

Effective Date :
EXPENSE CLAIM Revision : 00

Revision Date :

Name: Hafidz Deryantono Page: of

Assignment: Meeting Humpus Transportasi Kimia & Gas Emtec Job No.:

Net Amount
Original Claimed Exchange
No. Day Details of Expense Amount in Claimed
Currency Currency Rate
Currency
1 6-Mar-20 Ojek Online: Kantor - St. Rawa Buntu IDR 11,000
2 6-Mar-20 Ojek Online: St. Rawa Buntu - Kantor IDR 10,000
3 6-Mar-20 KRL: Rawa Buntu - Manggarai IDR 4,000

Claims will be processed upon approval with appropriate receipts attached. Total claimed: 25,000
Claimant Less advances:

Name & signature: Total due:

Hafidz Deryantono

Date: 5-Mar-20

Checked & Authorised by Management Checked by Accountant

Name & signature: Name & signature:

Date: Date: