Summary of Expenses Month:

Vivi Septiani Haryono Sep-21

Dept. Sales Departemen

No. Expenses Amount

1 Gasoline IDR 350,000
2 Travelling (Domestic) IDR -
3 Mobile Phone IDR 300,000
4 Postage&Courier IDR -
5 Entertainment_1 IDR -
6 Entertainment_2 IDR -
7 Travelling (Overseas) IDR -
8 Admin Misc IDR -
9 Others Expenses IDR -

Total Reimbursement IDR 650,000

 REIMBURSEMENT FORM
- Gasoline (Domestic) -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

05 September 2021 Fuel 100,000

24 September 2021 Fuel 100,000

27 September 2021 Fuel 150,000

Total Claimed 350,000

Remarks:
Request by: Verified by: (Manager Dept.) Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Travelling (Domestic) -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (Manager Dept.) Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Travelling (Domestic) -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Mobile Phone -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

01 September 2021 pulsa & data package 300,000

Total Claimed 300,000

Remarks:
Request by: Verified by: (Manager Dept.) Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

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Date : 03/05/2021 Date : /05/2021 Date : /05/2021

 REIMBURSEMENT FORM
- Postage & Courier -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (HOD) Approved by

Vivi Septiani Haryono Romi Suyantoro James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Entertainment 1 -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (Manager Dept.) Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Entertainment 2 -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Travelling (Overseas) -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date
 REIMBURSEMENT FORM
- Admin Miscellaneous -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: Approved by:

Vivi Septiani Haryono Angie Murti James Kim

Date : 01/10/2021 Date : /10/2021 Date : /10/2021 Date

 REIMBURSEMENT FORM
- Other Expenses -

Dept. Name: Date: Serial No:

Sales Departemen Vivi Septiani Haryono Sep-21

Date Description Amount (IDR)

Total Claimed -
Remarks:
Request by: Verified by: (HOD) Approved by

Vivi Septiani Haryono Angie Murti James Kim

Date : 02/09/2021 Date : /09/2021 Date : /09/2021 Date

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