MINISTRY OF HEALTH

National Center for Tuberculosis

and Leprosy Control
The Office of CENAT-SI
Statement of Expenditure (SOE) Part B
( Staff Personal Claimed )

PHD/OD/HF Name: HC Staff

Activity Description: ចុះស្រាវស្រាវជំងឺរបេងតាមបេេសកមមបៅOD កំពង់ស្ររឡាច បេរតកំពង់ឆ្នង
ំ

Budget Line# : 835

Date of Departure: On 07/ August /2022 To 12 / August / 2022 Mission to: OD កំពង់ស្ររឡាច បេរតកំពង់ឆ្នង
ំ

Mission Order No.:

Travel Voucher No.:

Perdiem stay night x n xx 1p = $ -

Return Day x d x 1p = $ -

Perdiem not stay night $ 14.00 x 1d x 1p = $ 14.00

Travel Cost x Trip = $ -

Total (1) = $ 14.00

Prepared by:

Name :
Position:

Mission Order No.:

Travel Voucher No.:

Perdiem stay night x n x 1p = $ -

Return Day x d x 1p = $ -

Perdiem not stay night $ 14.00 x 1d x 1p = $ 14.00

Travel Cost x Trip = $ -

Total (2) = $ 14.00

Prepared by:

Name :
Position:
 Mission Order No.:
Travel Voucher No.:
Perdiem stay night x n x 1p = $ -
Return Day x d x 1p = $ -
Perdiem not stay night $ 14.00 x 1d x 1p = $ 14.00
Travel Cost x Trip = $ -

Total (3) = $ 14.00

Prepared by:

Name :
Position:

Mission Order No.:

Travel Voucher No.:
Perdiem stay night x n x 1p = $ -
Return Day x d x 1p = $ -
Perdiem not stay night $ 14.00 x 1d x 1p = $ 14.00
Travel Cost x Trip = $ -

Total (4) = $ 14.00

Prepared by:

Name :
Position:

Grand Total (1+2+3+4) = $ 56.00

Certified by: Checked by: Prepared by:

(seen the list above)

Name: