LEAVE & BUSINESS TRAVEL FORM

Employee Data Date Prepared :

Name : Employment Status :
Payroll No. : Employment Date :
Department : Working Location :
Cost Center : Telephone Ext. No. :

LEAVE
Annual Leave Other Leave Reason :
Annual Leave Entitlement Year :
Leave Balance :
Leave Days Taken :
Leave Days Requested :
Effective Date From :
-
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 :
Telephone No.:

Prepared by
Prepared by Contractor Approval Client's Acknowledgement

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

* 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.
 LEAVE, BUSINESS TRAVEL & TRAINING APPLICATION FORM
Employee Data
Name : Your Name Employment Status : Permanent Employee
Payroll No. : ###### Employment Date : dd/mm/yy
Department : Department Working Location : mm/yy
Choose One Location
Cost Center : ####### Telephone Ext. No. : ####

LEAVE
Annual Leave Other Leave Reason :
Annual Leave Entitlement Year : #### Choose One Leave Reason (from Peraturan Perusahaan 2000-2002 Bab VI.)
Annual Leave Days Requested : ## days Leave Days Requested : ## days
Effective Date From : dd/mm/yy Effective Date From : dd/mm/yy
Until : dd/mm/yy Until : dd/mm/yy
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 : 1 days Your Last Clothing Allowance Amount Taken :
Effective Date From : dd/mm/yy Previous Overseas Country :
Until : dd/mm/yy Previous Overseas Business Travel Date From : dd/mm/yy
Business Travel Location : Overseas Domestic Until : dd/mm/yy
Business Travel Location Address :
Business Travel Purpose/Reason :

TRAINING Have You Ever Taken Overseas Training Before? Yes No

Training Days Requested : ## days Your Last Clothing Allowance Amount Taken :
Effective Date From : dd/mm/yy Previous Overseas Country :
Until : dd/mm/yy Previous Overseas Training Date From : dd/mm/yy
Training Location : Overseas Domestic Until : dd/mm/yy
Training Title :
Training Institution :
Training Objective :
Training Location Address :

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 :
Telephone No.:

Prepared by Approved by

sign here: sign here: sign here:

Employee Name Supervisor/Manager Name VP / President & Resident Manager
All higher management approval required (Supervisor/Manager/Vice President/President & Resident Manager) follows FAL regulation.

NOTE: For HR & Administration Purpose

* For Leave purpose: ANNUAL
when approved, this original form should be verified and sent to HR Relations. 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.