LEAVE & BUSINESS TRAVEL FORM

Employee Data Date Prepared : 12-May-2022

Name : HANIF FACHRIZAL Employment Status : Contract
Payroll No. : 122102013 Employment Date : 28-Mar-22
Department : AO SLO North Working Location : Rumbai, Pekanbaru
Cost Center : - Telephone Ext. No. : 87723726222

LEAVE
Annual Leave Other Leave Reason :-
Annual Leave Entitlement Year : 2022 -
Leave Balance : 12
Leave Days Taken : 0
Leave Days Requested : 3
Effective Date From : 17-May-2022
- 19-May-2022
I request to cash out : ___ days Remarks / Additional Note :-

BUSINESS TRAVEL Have You Ever Taken Overseas Business Travel Before? Yes No
Business Travel Days Requested : days Your Last Clothing Allowance Amount Taken :
Effective Date From : Previous Overseas Country :
Until : Previous Overseas Business Travel Date From :
Business Travel Location : Overseas Domestic Until :
Business Travel Location Address :
Business Travel Purpose/Reason :

Travel expenses to be reimbursed (for Domestic Business Travel & Training) : Actual Cost Lump-sum
NOTE: There is no lump-sum option if Business Travel or Training is conducted
(a) overseas (b) with company provided facilities (overseas & domestic). All expenses will be taken as actual cost.

MY CONTACT ADDRESS DURING LEAVE, BUSINESS TRAVEL & TRAINING:

Contact Address : Jl. Sman 1 Cibingbin No.1-3, Kel. Sukamaju, Kec. Cibingbin, Kab. Kuningan, Jawa Barat
45587 Telephone No.: 087723726222

Prepared by Contractor Approval Client's Acknowledgement

sign here; sign here: sign here: sign here: Sign here:

Hanif Fachrizal M. Afton Bambang Nursyahid

PT PDC Representative -
(PE Professional Eng.) (Team Manager Bekasap) (Manager AO SLO North)

* Client's Acknowledgement :
All higher management approval required (Supervisor/Manager/Vice President/President & GM) follows FAL regulation.

NOTE: For HR & Administration Purpose

* For Leave purpose: ANNUAL
when approved, this original form should be attached to Time Sheet LEAVE
* For Business Travel and/or Training purposes: OTHER
when approved, one copy of this form should be sent to HR Relations (for Business Travel) LEAVE
or HR Planning & Development (for Training verification) and the original should be attached BUSINESS
to the expense report to Finance. For any advance fund request, one copy of this form should be TRAVEL
attached to the Advance Request Form. TRAINING sign here:
LeaveTravelTrainingForm.xls/Idr.