Name as per NRIC : Muhammad Saifullah

Designation: Senior Executive

Date: 05-Sep-2022
Company: PT.DUNIA LUXINDO
Country : INDONESIA

STAFF CLAIM FORM

IMPORTANT
1 For Entertainment and CSR, please complete & attach together with the Entertainment Form and full tax invoice

2 For lost/no receipt, please complete and attach together with the No Receipt Form
3 For per diem meal allowance, please complete and attach together with the Per Diem Form
4 For Company activites/Team Welfare, please complete and attach together with the Team Welfare Form

Destination Bandung
Purpose of the Trip Stock Take Bandung August 2022
Travel Period 29 Aug - 3 Sept 2022

No. Date Expenses Incurred Description / Remarks Brand

1 29-Aug-22 PER DIEM MEALS ALLOWANCE Personal Meal Inventory

2 30-Aug-22 PER DIEM MEALS ALLOWANCE Personal Meal Inventory

3 31-Aug-22 PER DIEM MEALS ALLOWANCE Personal Meal Inventory

4 1-Sep-22 PER DIEM MEALS ALLOWANCE Personal Meal Inventory

5 2-Sep-22 PER DIEM MEALS ALLOWANCE Personal Meal Inventory

6 3-Sep-22 PER DIEM MEALS ALLOWANCE Personal Meal Inventory

TOTAL

For Administration use only:

Claimant
Name Muh. Saifullah Date 5-Sep-22

HOD Approval
(Obtain by Claimant) @ @
Name Date Name

C-Suite / Director Approval

(Obtain by Claimant) @
Name Date

* Lost/No receipt allowed to claim up to USD 15 only (or equivalent to local currency) per receipt
* All expenses must be claimed within sixty (60) days from the date of the expense incurred.
* All supporting receipts and invoices must be attached on an A4 size paper (recycled paper is acceptable) and numbered in sequence
accordingly to the number list on the Claim Form. (Paste all original receipts and invoices and remove all unnecessary staples).
* Please take note that claim cut off is on 7th and 21st of every month. Only completed form will be processed.
* Please refer to "Guidelines" tab on the expenses list and nature

** sample :
 Dept / Store: Inventory Count Executive
Employee # V003514

FORM

Store Currency Before GST Amount GST Amount Total Amount

MK PVJ IDR 300,000.00 300,000.00

VSD PVJ IDR 300,000.00 300,000.00

VSD PVJ IDR 300,000.00 300,000.00

VSD PVJ IDR 300,000.00 300,000.00

BBW PVJ IDR 300,000.00 300,000.00

BBW PVJ IDR 300,000.00 300,000.00

1,800,000.00 0.00 1,800,000.00

ministration use only:

Date
 DAILY PER DIEM ALLOWANCE CLAIM FORM

Name of Travellers Muhammad Saifullah

Employee ID V003514

Designation Senior Executive - Inventory Count

Company PT.DUNIA LUXINDO

Store Locations / Dept All Store Bandung

Travel Destination Bandung

Purpose of Trip Stocktake Bandung August 2022

Mode of Transport Train

Travel Period 29 Aug - 3 Sept 2022

I certify that these expenses were actual and reasonable and incurred for official business of Valiram Group that is :-

Yes
- Not part of personal extension trip No If Yes, please explain

- Not part of missed flight Yes No If Yes, please explain

- Not a delayed flight Yes No If Yes, please explain

- Gift Received during the trip Yes No If Yes, please explain

Departure Arrival
NO Origin Destination Meal provided
Date Time Date Time
NO MEAL
1 JAKARTA BANDUNG 29/Aug/22 4:55 29/Aug/22 7:52
PROVIDED

NO MEAL
2 BANDUNG 30/Aug/22 FULLDAY 30/Aug/22 FULLDAY
PROVIDED

NO MEAL
3 BANDUNG 31/Aug/22 FULLDAY 31/Aug/22 FULLDAY
PROVIDED

NO MEAL
BANDUNG 1/Sep/22 FULLDAY 1/Sep/22 FULLDAY
PROVIDED

NO MEAL
4 BANDUNG 2/Sep/22 FULLDAY 2/Sep/22 FULLDAY
PROVIDED

NO MEAL
5 BANDUNG JAKARTA 3/Sep/22 19:20 3/Sep/22 22:06
PROVIDED
KUL

Employee Signature : Muh. Saifullah Date : 5-Sep-22

Date

HOD Approval
Name
Date
C-Suite / Director Approval
Name

• Please
attached
• 100% per diem
supporting
allowance if a)
•document.
50% per diem
No meals if (ie
allowance
:
a) ,
flight itinerary
• No per diem
provided b)
One meal if all
e-ticket
allowance
Travel duration
(Lunch/dinner)
(train/rail,
meals
more than bus) ,
provided
provided
departure b)12
/
hours
Travel duration
arrival time )
less than 12 that any false declaration will result in disciplinary action including termination.
• I understand
hours
OWANCE CLAIM FORM

Valiram Group that is :-

No. of
days
Currency Per Diem Total Amount Remarks

No Lunch Provided Onboard

1 IDR 100% 300,000.00

1 IDR 100% 300,000.00

1 IDR 100% 300,000.00

1 IDR 100% 300,000.00

1 IDR 100% 300,000.00

1 IDR 100% 300,000.00