JSI Research & Training Institute, Inc. /JSI Inc.

(Data Use Partnership)

TRAVEL EXPENSE REPORT - FOR THE INTERNS
(Page 1 of 2)
Travel Information:
Name: Amare Belete Abebe

Purpose of Travel: To support dhis2 and other software,To support Denominator da

Libo WoHO, Woreta WoHO, A/Zemen Primary Hospital, Fogera
Destination: Tabor Refferal Hospital, WhO, Neface mewcha Hospital,A/Zemen
Dates of Travel: From: 8-Oct-20 To:
12-Oct-20 To:
19-Oct-20 To:
Means of Travel: Both public transport and Government transport

Project/Activity Code:

Travel Expense report

Arrival Departure M& IE - For
Date Time Date Time City # Days Rate

Addis zemen
primary
10/13/2020 Hospital,Libo
kemkem
9-Oct-20 WoHO,A/Zemen
Woreta 3 $300.00
WoHO ,Woreta
14-Oct-20 15-Oct-20 HC 2
16-Oct-20 16-Oct-20 Fogera WoHO 1
Nefase mewcha
Primary Hospital
17-16/10/2020 19-Oct-20 and WoHO , 3
20-Oct-20 21-Feb-20 Alember HC,Weji 2
22-Oct-20 22-Feb-20 Yifage HC 1
Subtotal M&IE:

Other Expenses: (Transportation)

Rec. # Date Description Account Code
8/10/202-
9/10/2020 D/Tabor to Addis Zemen
 Total Other Expenses:

Total Expense Calculation (to be completed by Accounting):

Travel Expense ETB 3,600.00 Total Expenses:
Other Expense ETB 100.00 Advance Received V#
Total Expenses: ETB 3,700.00 Amount Owed/return:

Travel Signature / confirmation:

Signature: Amare Belete

Date: 10/24/2020
Checked by: Approved by:
Name: Name:

Signature: Signature:

Date: Date:
artnership)
NS

ominator data set report filled,

pital, Fogera WoHO, Debre Tabor WoHO Debre
tal,A/Zemen HC,
9-Oct-20
16-Oct-20
22-Oct-20

M& IE - For Accounting Use Only

Total

$900.00

$600.00
$300.00

$900.00
$600.00
$300.00
$3,600.00

Amount

ETB100.00
 ETB 100.00

ting):
ETB 3,600.00

ETB 3,700.00