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BUSINESS TRIP REPORT

(Form T-3)

NO : : 019565
Status : Approved
Request No : 0126/DSLNG/BTAF/12/2022
Name : BAMBANG YANU PURWANTO
ID : 2022120678
Directorate : President Director Office/QHSE
Position : Industrial Hygiene Specialist
Travel Type : ROTATION
Rotation 28:28
Purpose :
#Taking 29 days off due to adjustment schedule

Destination

Start Date End Date From Destination Overseas Remark / Purpose


10 Jan 2023 10 Jan 2023 Luwuk Makassar N BATIK AIR / ID 8293 (B)

Luwuk Airport (LUW) - Tuesday, 10 Jan


2023 12:15 (UTC+8)
Soekarno Hatta (CGK) - Tuesday, 10 Jan
2023 17:05 (UTC+7)
Transportation : AIR
Transportation Class : Economy Transportation Class Remark :-
Accomodation Class : None Accomodation Class Remark :-
Room Type Class : None Room Type Remark :-
10 Jan 2023 10 Jan 2023 Makassar Jakarta N BATIK AIR / ID 8293 (B)
Luwuk Airport (LUW) - Tuesday, 10 Jan
2023 12:15 (UTC+8)
Soekarno Hatta (CGK) - Tuesday, 10 Jan
2023 17:05 (UTC+7)
Transportation : AIR
Transportation Class : Economy Transportation Class Remark :-
Accomodation Class : None Accomodation Class Remark :-
Room Type Class : None Room Type Remark :-
11 Jan 2023 06 Feb 2023 Jakarta Jakarta N OFF DUTY
Transportation : LAND
Transportation Class : None Transportation Class Remark : NONE
Accomodation Class : None Accomodation Class Remark :-
Room Type Class : None Room Type Remark :-
07 Feb 2023 07 Feb 2023 Jakarta Makassar N BATIK AIR / ID 6292 (Y)

Soekarno Hatta (CGK) - Tuesday, 07 Feb


2023 08:30 (UTC+7)
Luwuk Airport (LUW) - Tuesday, 07 Feb
2023 13:50 (UTC+8)
Transportation : AIR
Transportation Class : Economy Transportation Class Remark :-
Accomodation Class : None Accomodation Class Remark :-
Room Type Class : None Room Type Remark :-
07 Feb 2023 07 Feb 2023 Makassar Luwuk N BATIK AIR / ID 6292 (Y)

Soekarno Hatta (CGK) - Tuesday, 07 Feb


2023 08:30 (UTC+7)
Luwuk Airport (LUW) - Tuesday, 07 Feb
Claim no :019565 - Page 1 of 3
BUSINESS TRIP REPORT
(Form T-3)

2023 13:50 (UTC+8)


Transportation : AIR
Transportation Class : Economy Transportation Class Remark :-
Accomodation Class : None Accomodation Class Remark :-
Room Type Class : None Room Type Remark :-

1. Daily Allowance

Start Date End Date Night(s) Curr Nominal Amount Exchange Rate IDR Amount Remarks
10 Jan 2023 10 Jan 2023 1.0 IDR 300,000.00 1.00 300,000.00

07 Feb 2023 07 Feb 2023 1.0 IDR 300,000.00 1.00 300,000.00

Total 2.0 IDR 600,000.00 600,000.00

2. General Expense

Expense Date Expense Name Curr Nominal Amount Exchange Rate IDR Amount Remarks
BREAKFAST IDR 50,000.00 1.00 50,000.00 Breakfast at Soekarno
07 Feb 2023
ALLOWANCE Hatta Airport
Total IDR 50,000.00 50,000.00

3. Cash Advance

Expense Name Curr Nominal Amount Exchange Rate IDR Amount Remarks
- - 0.00 0.00 0.00

Total - 0.00 0.00

Claim no :019565 - Page 2 of 3


BUSINESS TRIP REPORT
(Form T-3)

Grand Total (1+2) 650,000.00


Cash Advance (3) 0.00
Balance due to Employee 650,000.00
Balance due to Company

Detail Account
Name BAMBANG YANU PURWANTO
Bank MANDIRI
Branch KCP SERANG PASAR ANYER 16306
Acc. Number 1630003501874

Requested by Acknowledged by Verified by Verified by Approved by

SUBMITTED ACKNOWLEDGED VERIFIED VERIFIED APPROVED

23 Feb 2023 25 Feb 2023 08 Mar 2023 08 Mar 2023 09 Mar 2023

BAMBANG YANU MARCELLA INGGRID


BOY HIDAYAT ROY ALI MANGAMBALI AKHMAD KHAQIM
PURWANTO SALFISCHBERGER

Industrial Hygiene
Chief Medical Officer HR Support Officer HR Operations Manager QHSE Senior Manager
Specialist

Claim no :019565 - Page 3 of 3

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