PT.

MITRA KIARA INDONESIA Expense Claim

Employee

Period
Name: From:
Department To:

Airfare / Bus / Lodging / Meals / Rental Telephone / Fuel /Parking / Milleage (Rate Other /
No Date Paid to Description Doc No. Train / Taxi Hotel restaurant Entertainment *) Kendaraan Internet Toll IDR XXX/Km) Supplies sundry Total

1 0
2 -
3 -
4 -
5 -
6 -
7 -
8 -
9 -
10 -
11 -
12 -
13 -
14 -
15 -
16 -
17 -
18 -
19 -
20 -
21 -
22 -
0 0 0 0 0 0 0 0 0 0

Proposed By

Subtotal 0

Less : Cash Advances -

Date : 1 Nov 2019

0 Total Claims 0
Notes
Detail for Entertainment Expenses
Note: For Entertainment Expenses, please indicate business
purpose and who attended

*Mileage rate : IDR …………… per KM

Notes
sesuai peraturan HRD yang berlaku
 PT. MITRA KIARA INDONESIA

Persetujuan Perjalanan Dinas

PT. MITRA KIARA INDONESIA
Date: …./……/20…
Expense Claim

Employee Period
Name: WIRAWAN KOSASIH From: OKTOBER 19
Department FINANCE To: OKTOBER 19

Airfare / Bus / Telephone / Fuel /Parking / Milleage (Rate

No Date Paid to Description Doc No. Train / Taxi Lodging / Hotel Meals / restaurant Entertainment *) Rental Kendaraan Internet Toll IDR XXX/Km) Supplies Other / sundry Total
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
16 0
17 0
18 0
19 0
20 0
21 0
22 0
0 0 0 0 0 0 0 0 0 0

Proposed By
Approved By Approved By Approved By Approved By

Subtotal 0

Less : Cash Advances

Date : Date : Date : Date : Date :

Employee Direct Manager Division Head Direct Director President Director Total Claims 0

Notes
Detail for Entertainment Expenses Approved By Approved By
Note: For Entertainment Expenses, please indicate business
purpose and who attended

*Mileage rate : IDR …………… per KM

Notes Date : Date :
sesuai peraturan HRD yang berlaku Accounting / AP Treasury
PT. MITRA KIARA INDONESIA
DAFTAR NOMINATIF BIAYA ENTERTAINMENT DAN SEJENISNYA
Tahun Pajak : 2020
PEMBERI ENTERTAINMENT DAN SEJENISNYA

NO. TANGGAL TEMPAT ALAMAT

TOTAL

Jakarta, 2020

Proposed By

Date:

_______________________
AN SEJENISNYA RELASI USAHA YANG DIBERIKAN ENTERTAINMEN

JENIS JUMLAH (Rp) NAMA POSISI

Approved By

Date:

_________________________
A YANG DIBERIKAN ENTERTAINMENT

NAMA PERUSAHAAN JENIS USAHA KETERANGAN

PT. MITRA KIARA INDONESIA CLAIMS WITHOUT EVIDENCE/
Date:
PENGELUARAN TANPA BUKTI

Name:
Department

Saya menyatakan dengan sebenarnya bahwa saya telah membayarkan pengeluaran untuk keperluan berikut dan tidak menerima bukti pembayaran dari penerima

Explanation why there is no payment evidence /

Date / Paid to / Nama
No Description / Penjelasan Penjelasan kenapa tidak mendapatkan bukti Amount / Jumlah (Rp)
Tanggal Penerima
pembayaran

10

Note :

Proposed By Approved By

Date: Date:
_______________________ _________________________
Employee Direct Manager

Notes
PT. MITRA KIARA INDONESIA
MEDICAL CLAIM

Period
Name: From:
Department To:

Patient Name / Hospital / Doctor Name /Nama Employee / Spouse / Istri /

No Date/ Tanggal Children / Anak Total
Nama Pasiesn Rumah Sakit / Dokter Karyawan Suami

1 0 0

2 0

3 0

4 -

5 -

6 -

7 -

8 -

9 -

10 -

11 -

12 -

13 -

14 -

15 -

16 -

17 -

18 -

19 -

20 -
0 0 0 0
Proposed By

Date: 22 Januari 2020

__________________________
0
Gd. Artha Graha Lt. 20
Jl. Jend. Sudirman kav. 52
Jakarta 12190

SURAT PENGAJUAN PERJALAN DINAS

No. ___/SPPD-MKI/XI/19

Nama :
Jabatan :
Keperluan :
Tujuan :
Tgl. Berangkat : Tgl.25/09/2018 Jam :
Waktu kembali : Tgl.26/09/2018 Jam :
Lama Perjalanan : 2 hari Hari : 1 Malam
Transportasi antar kota : Pesawat Terbang

Uang Muka Perjalanan Dinas

Uraian Budget Realisasi Keterangan
- Uang saku Rp.100.000,-/hari 200,000
- Uang saku Rp.200.000,-/hari 400,000
- Uang makan Rp.150.000/hari 300,000

Jumlah 900,000 -
Note :
Uang muka perjalanan dinas akan dipertanggungjawabkan maks.3 hari setelah perjalanan dinas selesai

Jakarta, 24 September 2018 Mengetahui, Menyetujui,

Diajukan oleh

( ….. ) Wirawan Kosasih Bagus Dwi Wasono

Finance Controller Direktur