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Month : Apr-16

COP - OPERATIONAL COST (COPOC) Form

Employee No. : 3100175

Name : Shirly Handajani

Cost Center : 715141051

Level : Manager

Department / Division : P-Log / Supply Chain


Location : Surabaya DC

Supporting tickets of COPOC :

Operational Cost Amount

1 CRE (gasoline, toll, parking) ( 2.352.000)


2 M&R ( 1.304.600)
3 Private Driver (VP only) ( -  )

Total Amount : ( 3.656.600)

Prepared by : Received by :

Signature & Name of Employee HR Benefits/Site HR

I understood that :
- If the amount written in this form is higher than the total of supporting tickets, the amount of
supporting tickets will be used.
- If the total amount of supporting tickets is less than the reimbursement, the different amount will
be subject for tax deduction.
- If I do not submit the operational cost up to the deadline, the operational cost of the respective
month will be considered as 'No record' and be deducting by income tax
Month : Mei-16

COP - OPERATIONAL COST (COPOC) Form

Employee No. : 3100175

Name : Shirly Handajani

Cost Center : 715141051

Level : Manager

Department / Division : P-Log / Supply Chain


Location : Surabaya DC

Supporting tickets of COPOC :

Operational Cost Amount

1 CRE (gasoline, toll, parking) ( 2.075.000)


2 M&R ( 165.000)
3 Private Driver (VP only) ( -  )

Total Amount : ( 2.240.000)

Prepared by : Received by :

Signature & Name of Employee HR Benefits/Site HR

I understood that :
- If the amount written in this form is higher than the total of supporting tickets, the amount of
supporting tickets will be used.
- If the total amount of supporting tickets is less than the reimbursement, the different amount will
be subject for tax deduction.
- If I do not submit the operational cost up to the deadline, the operational cost of the respective
month will be considered as 'No record' and be deducting by income tax
Month : Jun-16

COP - OPERATIONAL COST (COPOC) Form

Employee No. : 3100175

Name : Shirly Handajani

Cost Center : 715141051

Level : Manager

Department / Division : P-Log / Supply Chain


Location : Surabaya DC

Supporting tickets of COPOC :

Operational Cost Amount

1 CRE (gasoline, toll, parking) ( 1.827.000)


2 M&R ( 2.071.500)
3 Private Driver (VP only) ( -  )

Total Amount : ( 3.898.500)

Prepared by : Received by :

Signature & Name of Employee HR Benefits/Site HR

I understood that :
- If the amount written in this form is higher than the total of supporting tickets, the amount of
supporting tickets will be used.
- If the total amount of supporting tickets is less than the reimbursement, the different amount will
be subject for tax deduction.
- If I do not submit the operational cost up to the deadline, the operational cost of the respective
month will be considered as 'No record' and be deducting by income tax
Month : Jul-16

COP - OPERATIONAL COST (COPOC) Form

Employee No. : 3100175

Name : Shirly Handajani

Cost Center : 715141051

Level : Manager

Department / Division : P-Log / Supply Chain


Location : Surabaya DC

Supporting tickets of COPOC :

Operational Cost Amount

1 CRE (gasoline, toll, parking) ( 2.344.100)


2 M&R
3 Private Driver (VP only) ( -  )

Total Amount : ( 2.344.100)

Prepared by : Received by :

Signature & Name of Employee HR Benefits/Site HR

I understood that :
- If the amount written in this form is higher than the total of supporting tickets, the amount of
supporting tickets will be used.
- If the total amount of supporting tickets is less than the reimbursement, the different amount will
be subject for tax deduction.
- If I do not submit the operational cost up to the deadline, the operational cost of the respective
month will be considered as 'No record' and be deducting by income tax
Month : Agu-16

COP - OPERATIONAL COST (COPOC) Form

Employee No. : 3100175

Name : Shirly Handajani

Cost Center : 715141051

Level : Manager

Department / Division : P-Log / Supply Chain


Location : Surabaya DC

Supporting tickets of COPOC :

Operational Cost Amount

1 CRE (gasoline, toll, parking) ( 2.246.000)


2 M&R
3 Private Driver (VP only) ( -  )

Total Amount : ( 2.246.000)

Prepared by : Received by :

Signature & Name of Employee HR Benefits/Site HR

I understood that :
- If the amount written in this form is higher than the total of supporting tickets, the amount of
supporting tickets will be used.
- If the total amount of supporting tickets is less than the reimbursement, the different amount will
be subject for tax deduction.
- If I do not submit the operational cost up to the deadline, the operational cost of the respective
month will be considered as 'No record' and be deducting by income tax

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