ENERGIA MTC LLC

Al Jubail, K.S.A.
EMPLOYEE REIMBURSEMENT FORM

Name : SYED KHALANDER EMP ID ENR-EMP-1262

Line Manager
Name Akram Perviz EMP ID 1262

Date : 1/Jun/21 Department : OM-46 Project

Expenses Type Summery report (Attach your approved travel request)

No of days:
Bills Summary
Sl No Description Bill No. Amount (SAR)
Roikbaa site expenses
1 Mobile Recharge 7576 130.00
2 Room rent for rental operators 20/6/21 to 20/7/21 1587 700.00
3 LT PUMP OIL HOSE REPARIED 4 PIECE 2403 100.00
4 PURCHASED CANON BLACK INK FOR PRINTER 3177 89.00
5 TO CLEAN GENSET PURCHASED WASHING POWDER & BRUSH 1541 69.00
6 CAR WASH 9/6/21 2487 20.00
7 CAR WASH 24/6/21 0019 20.00
8 Purchased Drinking water for site 7/6/21 5783 69.00
9 Purchased Drinking water for site 14/6/21 9005 69.00
10 Purchased Drinking water for site & Garbage bag 19/6/21 9005 96.00
11 Water for site porta cabin 2/6/21 0947 30.00
12 Water for site porta cabin 4/6/22 0948 30.00
13 Water for site porta cabin 10/6/21 0949 30.00
14 Water for site porta cabin 11/6/21 0950 30.00
15 Water for site porta cabin 15/6/23 0951 30.00
16 Water for site porta cabin 18/6/24 0635 30.00
17 Water for site porta cabin 24/6/21 0952 30.00
PETROL
1 Refill petrol Veh No: 1219 LBD at Km162236 11220 92.00
2 Refill petrol Veh No: 1219 LBD at Km162786 06725 94.00
3 Refill petrol Veh No: 1219 LBD at Km163168 044505 95.00
4 Refill petrol Veh No: 1219 LBD at Km163648 19601 97.00
5 Refill petrol Veh No: 1219 LBD at Km164140 11126 88.00
6 Petrol for jet Washer 4598 50.00
7 Refill petrol Veh No: 1219 LBD at Km164635 4225 70.00
MATERIAL TAKEN FOR SITE
1 Purchased Thread tool 37633 40.00
2 Rubber washers 37817 17.00
3 Purchased waste cloth,electrical tape,teflon tape 38026 60.00
4 Purchased torch lights for site 10849 135.00
5 White cleaning cloth 40901 120.00
6 Purchased grease 41264 34.00
7 Arabia tires 42361 49.00
8 Rental opertator medical expenses 40916 90.00
9 zerox log sheets 300 copies 0956 60.00
10 zerox A1 size SLD 0958 20.00
11 Cover all washing 1317 120.00

Received by: Total 2,903.00

Ref No. (Office use)
Voucher No.
(Office use)
 ENERGIA MTC LLC
Al Jubail, K.S.A.
EMPLOYEE REIMBURSEMENT FORM

Name : SYED KHALANDER EMP ID ENR-EMP-1262

Line Manager
Name Akram Perviz EMP ID 1262

Date : 1/Jun/21 Department : OM-46 Project

Expenses Type Petrol expenses (Attach your approved travel request)

No of days:
Bills Summary
Sl No Description Bill No. Amount (SAR)
1 Refill petrol Veh No: 1219 LBD at Km162236 11220 92.00
2 Refill petrol Veh No: 1219 LBD at Km162786 06725 94.00
3 Refill petrol Veh No: 1219 LBD at Km163168 044505 95.00
4 Refill petrol Veh No: 1219 LBD at Km163648 19601 97.00
5 Refill petrol Veh No: 1219 LBD at Km164140 11126 88.00
6 Refill petrol Veh No: 1219 LBD at Km164635 44225 70.00
7 Petrol for jet Washer 446598 50.00
Total Expenses 586.00
Less: Advances
Balance (+ / -) 586.00
Amount in
words
Siganture Date
I hereby certify that I have incurred all of the
Employee 6/1/2021
above expenses on behalf of ENERGIA.

Supervisor's signature verifies that the expense was

Head of necessary,reasonable and in accordance with
Department Company policy, and required documentation is
attached.

Finance verifies whether the supporting documents

Finance
match with this claim .

Received by:
Ref No. (Office use)
Voucher No.
(Office use)
 ENERGIA MTC LLC
Al Jubail, K.S.A.
EMPLOYEE REIMBURSEMENT FORM

Name : SYED KHALANDER EMP ID ENR-EMP-1262

Line Manager
Name Akram Perviz EMP ID 1262

Date : 1/Jun/21 Department : OM-46 Project

Expenses Type Najran Al roikbha (Attach your approved travel request)

No of days:
Bills Summary
Sl No Description Bill No. Amount (SAR)
1 Mobile recharge 7576 130.00
2 Room rent for rental operators 20/6/21 to 20/7/21 1587 700.00
3 LT PUMP OIL HOSE REPARIED 4 PIECE 2403 100.00
4 PURCHASED CANON BLACK INK FOR PRINTER 3177 89.00
5 TO CLEAN GENSET PURCHASED WASHING POWDER & BRUSH 1541 69.00
6 CAR WASH 9/6/21 2487 20.00
7 CAR WASH 24/6/21 0019 20.00
8 Purchased Drinking water for site 7/6/21 5783 69.00
9 Purchased Drinking water for site 14/6/21 9005 69.00
10 Purchased Drinking water for site & Garbage bag 19/6/21 2640 96.00
12 Water for site porta cabin 2/6/21 0947 30.00
13 Water for site porta cabin 4/6/22 0948 30.00
14 Water for site porta cabin 10/6/21 0949 30.00
15 Water for site porta cabin 11/6/21 0950 30.00
16 Water for site porta cabin 15/6/23 0951 30.00
17 Water for site porta cabin 18/6/24 0635 30.00
18 Water for site porta cabin 24/6/21 0952 30.00
1 Purchased Thread tool 37633 40.00
2 Rubber washers 37817 17.00
3 Purchased waste cloth,electrical tape,teflon tape 38026 60.00
4 Purchased torch lights for site 10849 135.00
5 White cleaning cloth 40901 120.00
6 Purchased grease 41264 34.00
7 Arabia tires 42361 49.00
8 Rental opertator medical expenses 40916 90.00
9 zerox log sheets 300 copies 0956 60.00
10 zerox A1 size SLD 0958 20.00
11 Cover all washing 120.00
Less: Advances
Balance (+ / -) 2,317.00
Amount in
words
Siganture Date
I hereby certify that I have incurred all of the
Employee 6/1/2021
above expenses on behalf of ENERGIA.

Supervisor's signature verifies that the expense was

Head of necessary,reasonable and in accordance with
Department Company policy, and required documentation is
attached.

Finance verifies whether the supporting documents

Finance
match with this claim .

Received by:
Ref No. (Office use)
Voucher No.
(Office use)