Name

For Purchase Ledger Use

Position EXPENSE CLAIM FORM Documen

t Number
CASH
All expenses must match the statement/Receipts
Month
Statemen
t date

Enter amounts in the appropriate analysis column below

Gross Amount Phone Car Parking Business UAE Travel Overseas Hotels & Hotels & Training Business Staff Meals on Audit / Sundry Other Total
Statement Receipt Nett amount Mileage Travel Meals & Subs Meals out of Entertaining Entertain Duty Consultin Office Check
Business Justification shown on Paid cash
/Receipt Date Number (AED) UAE UAE ment g Supplies
receipt (AED)
AED
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - AED 43,011.00 -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
TOTALS - - - 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00

I agree that the expenses listed above have bee Authorised By: Notes for Completion

are claimed in line with the Expenses Policy

Statement Date - Enter the expense date shown on the statement
Signature: Receipt Number - Write the corresponding number on the receipt to ensure it matches the statement - receipts should be in
date order
Employee Business Justification - Enter the reason and justification for the expense in line with the Expenses policy.
Signature: Gross Amount - This is the total amount being claimed - where appropriate, it will include VAT
VAT - If VAT is shown on the receipt, enter it in this column. If VAT is not shown on the receipt - do not fill in anything in this
Date : box.
NETT Amount - This is the amount without the VAT included. The spreadheet will automatically work out the VAT element at
Date : the relevant rate.
Columns - Enter the NETT amount into the appropriate column to categorise the expense. The cross check column at the
end should have 0.00 in it.
Name:
This form must be approved and returned to finance within 14 days
from receipt of the statement.
Failure to return an approved form to finance wit Position:
 the relevant rate.
Columns - Enter the NETT amount into the appropriate column to categorise the expense. The cross check column at the
end should have 0.00 in it.

will result in the card being withdrawn from the holder

 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
For Pre Opening Expense - Eat Greek
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Goods Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
11/26/2022 221126 Wooden Round Table Display - Eat Greek requirement QR 602.92 1.0000 602.92 - 602.92 - - - used at table set up 602.92
11/25/2022 4497 Letra Tag for Labelling QR 142.00 1.0000 142.00 - - 142.00 - - used for labeling items 142.00
11/26/2022 234622 Tamper Mat QR 72.00 1.0000 72.00 - 72.00 - - - for coffee set up 72.00
11/26/2022 234621 Knock Out Drawer Box QR 265.00 1.0000 265.00 - 265.00 - - - for coffee set up 265.00
11/27/2022 262 Food Ingredients - food trial QR 1.0000 - - 10.20 - - - food trial ingredients 10.20
11/19/2022 11348 Padlocks for Knives QR 1.0000 - - 100.00 - - - knives lock 100.00

****************************** Nothing Follows ************

TOTAL 1,081.92 1,081.92 - 939.92 142.00 - - 1,081.92

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
For Pre Opening Expense - WGMM
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Goods Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
11/26/2022 80468847 Chilli Oil Bottle QR 228.00 1.0000 228.00 - 228.00 - - - used at table set up 228.00
11/26/2022 234623 Tamper Mat QR 52.00 1.0000 52.00 - 52.00 - - for coffee set up 52.00
11/26/2022 1000000179 wagamama Brand Chef Gift QR 88.80 1.0000 88.80 - - - - 88.80 gift for brand Chef Dawid 88.80
****************************** Nothing Follows ************
TOTAL 368.80 368.80 - 280.00 - - 88.80 368.80

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion
Statement Date - Enter the expense date shown on the
and claimed in line with the Group Expense Policy
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
For Pre Opening Expense - Eat Greek
Statement date
Company: 2975
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Goods Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
11/29/2022 11 Edamame Frozen 500g x 4 QR 87.00 1.0000 87.00 - 87.00 - - - run out of supplies 87.00
11/29/2022 22 Food Items - Lemons 5.082kilos QR 27.95 1.0000 27.95 - 27.95 - - - run out of supplies 27.95
11/29/2022 22 Food Items - Spring onions and kaffir leaves QR 31.70 1.0000 31.70 - 31.70 - - - run out of supplies 31.70
11/29/2022 22 Food Items - Kale / Mixed Letuce 1.250kilos QR 261.25 1.0000 261.25 - 261.25 - - - run out of supplies 261.25
11/29/2022 22 Food Items - Pangko Crumbs 3kilos QR 80.25 1.0000 80.25 - 80.25 - - - run out of supplies 80.25
11/29/2022 22 Food Items - Udon Noodles 3kilos QR 63.75 1.0000 63.75 - 63.75 - - - run out of supplies 63.75
11/29/2022 22 Food Items - Ramen Noodles 3.8kilos QR 80.75 1.0000 80.75 - 80.75 - - - run out of supplies 80.75
11/29/2022 22 Food Items - Sweet Corn 2.975kilos QR 58.00 1.0000 58.00 - 58.00 - - - run out of supplies 58.00
11/29/2022 1143 Tape Letra tag 12mmx4m 2rolls QR 130.00 1.0000 130.00 - 130.00 - - - used for labeling items 130.00

****************************** Nothing Follows ************

TOTAL 820.65 820.65 - 820.65 - - - 820.65

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mularaju Yerramsetti
For Purchase Ledger Use
Position:
Team Member Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
Travel Expense
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Goods Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
11/1/2022 53873 Grand Excelsior Hotel - Tax Tourist AED 15.00 0.9000 13.50 - - - - 15.00 Hotel Tourist Tax 15.00
11/2/2022 53892 Grand Excelsior Hotel - Tax Tourist AED 50.00 0.9000 45.00 - - - - 50.00 Hotel Tourist Tax 50.00
****************************** Nothing Follows ************

TOTAL 65.00 58.50 - - - - 65.00 65.00

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager
Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
For Pre Opening Expense - Wagamama
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Goods Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
11/16/2022 1141 Passion Fruit Monin Syrup 750ml QR 38.50 1.0000 38.50 - 38.50 - - - mocktails trial ingredients 38.50
11/15/2022 101 Fresh Passion Fruit; Fresh Lime Green; Fresh Lemon QR 131.30 1.0000 131.30 - 131.30 - - - mocktails trial ingredients 131.30
11/23/2022 20221123 Kitchen Towel QR 27.75 1.0000 27.75 - 27.75 - - - pre opening supplies 27.75
11/20/2022 4133 Labeller Sticker 2pcs @ 71QR QR 142.00 1.0000 142.00 - 142.00 - - - pre opening supplies 142.00
11/23/2022 595 Labeller Sticker 2pcs @ 71QR QR 142.00 1.0000 142.00 - 142.00 - - - pre opening supplies 142.00
11/15/2022 809385/2022 Stationary QR 130.00 1.0000 130.00 - 130.00 - - - pre opening supplies 130.00
11/14/2022 0093 Squid Fresh QR 32.00 1.0000 32.00 - 32.00 - - - food trial 32.00
11/15/2022 Flash Drive QR 50.00 1.0000 50.00 - 50.00 - - - pre opening supplies 50.00
11/17/2022 233495 Knock out Box - for Coffee QR 265.00 1.0000 265.00 - 265.00 - - - pre opening supplies 265.00

****************************** Nothing Follows ************

TOTAL 958.55 958.55 - 958.55 - - - 958.55

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date :
included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
For Pre Opening Expense - Eat Greek
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Goods Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
11/29/2022 60241776 Cutlery holder @ 5 QR 35.00 1.0000 35.00 - 35.00 - - - pre opening supplies 35.00
11/29/2022 60241776 Cutlery holder - 2 @ 29Qr each QR 58.00 1.0000 58.00 - 58.00 - - - pre opening supplies 58.00
11/29/2022 60241775 Bottle for Olive Oil - 16 @ 17Qr each QR 112.00 1.0000 112.00 - 112.00 - - - pre opening supplies 112.00
11/29/2022 60241775 Bottle Stopper @4 19Qr each QR 76.00 1.0000 76.00 - 76.00 - - - pre opening supplies 76.00
11/29/2022 60241775 Bottle for Olive Oil @8 21Qr each QR 168.00 1.0000 168.00 - 168.00 - - - pre opening supplies 168.00
11/30/2022 4117 Menu Folder @3pcs 81Qr each QR 243.00 1.0000 243.00 - 243.00 - - - pre opening supplies 243.00
11/30/2022 5481 Menu Folder @3pcs 81Qr each QR 243.00 1.0000 243.00 - 243.00 - - - pre opening supplies 243.00
11/30/2022 629801 Passion Fruit Pack @18Qr per pack QR 90.00 1.0000 90.00 - 90.00 - - - pre opening supplies 90.00
12/1/2022 830084 Gyros Wrap
Passion Fruit Monin Syrup QR 7.00 1.0000 7.00 - 7.00 - - - pre opening supplies 7.00
11/30/2022 276964 750ml QR 98.50 1.0000 98.50 - 98.50 - - - pre opening supplies 98.50
12/3/2022 235128 Rectangular Dish Deep - Enoteca QR 97.00 1.0000 97.00 - 97.00 - - - pre opening supplies 97.00
12/3/2022 235106 Knock Out Box - Simit Sraya QR 265.00 1.0000 265.00 - 265.00 - - - pre opening supplies 265.00
11/25/2022 20221125 Handwash and Oasis Wipes Roll; Tofu Soft - Wagamama QR 1.0000 - - - - - - pre opening supplies -
12/3/2022 235106 Padlocks for Knives & Markers - WGM, Enoteca,Egrk,Motta QR 1.0000 - - - - - - pre opening supplies -

****************************** Nothing Follows ************

TOTAL 1,492.50 1,492.50 - 1,492.50 - - - 1,492.50

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
For Pre Opening Expense - Expansion
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Goods Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
-
11/25/2022 20221125 Handwash and Oasis Wipes Roll; Tofu Soft - Wagamama QR 168.50 1.0000 168.50 - 168.50 - - - pre opening supplies 168.50
12/3/2022 235106 Padlocks for Knives & Markers - WGM, Enoteca,Egrk,Motta QR 59.00 1.0000 59.00 - 59.00 - - - pre opening supplies 59.00
****************************** Nothing Follows ************
-
-
-
-
-
-
-
-

TOTAL 227.50 227.50 - 227.50 - - - 227.50

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Mohamed Rostum
For Purchase Ledger Use
Position:
Procurement Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason: For Pre Opening Expense -
Enoteca/Motta/Wagamama/EatGrk
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Goods Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
12/12/2022 Salad Bowl - Antipasti Bowl Display (Enoteca) QR 173.60 1.0000 173.60 173.60 pre opening crockery requirement 173.60
12/12/2022 Rectangular Black Dish for Lasagna (Enoteca & Motta) QR 638.40 1.0000 638.40 - 638.40 - - - pre opening crockery requirement 638.40
12/12/2022 Rectangular Black Dish for Meatballs (Enoteca & Motta) QR 378.00 1.0000 378.00 - 378.00 - - - pre opening crockery requirement 378.00
12/12/2022 Round Black Dish for Baked Pasta (Motta) QR 252.00 1.0000 252.00 - 252.00 - - - pre opening crockery requirement 252.00
12/16/2022 Baby Spinach (wagamama) QR 39.00 1.0000 39.00 - 39.00 - - - OOS from main store on Friday 39.00
12/16/2022 Bean Sprouts (wagamama) QR 78.54 1.0000 78.54 - 78.54 - - - OOS from main store on Friday 78.54
12/16/2022 Lime Green Fresh (wagamama) QR 8.75 1.0000 8.75 - 8.75 - - - OOS from main store on Friday 8.75
12/17/2022 Gyros Brown Paper underliner (Eat Greek) QR 35.00 1.0000 35.00 - 35.00 - - - pre opening crockery requirement 35.00
****************************** Nothing Follows ************
-
-
-

TOTAL 1,603.29 1,603.29 - 1,603.29 - - - 1,603.29

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Rachell Austria Hempisalla
For Purchase Ledger Use
Position:
Multistore Unit Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
Medical Expense
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Goods Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
1/2/2023 101021448332 Emergency Visit QAR 100.00 1.0000 100.00 Medical expense 100.00
1/2/2023 101021448528 Medicine - Pharmacy QAR 20.33 1.0000 20.33 Medical expense 20.33
1/3/2023 457320 Laboratory Test - Complete Blood Count QAR 120.00 1.0000 120.00 Medical expense 120.00
1/3/2023 457320 Laboratory Test - Prothrombin Time (PT) QAR 180.00 1.0000 180.00 Medical expense 180.00
1/3/2023 457320 Laboratory Test - Thromboplastin Time (APTT) QAR 180.00 1.0000 180.00 Medical expense 180.00
1/3/2023 457339 General Surgery Consultation QAR 300.00 1.0000 300.00 Medical expense 300.00
1/3/2023 457339 Radiology - U/S Leg Vascular (One Left leg) QAR 600.00 1.0000 600.00 Medical expense 600.00
****************************** Nothing Follows ************

TOTAL 1,500.33 1,500.33 - - - - - 1,500.33

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion
Statement Date - Enter the expense date shown on the
and claimed in line with the Group Expense Policy
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Rachell Austria Hempisalla Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : 1/3/2023 included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Rachell Austria Hempisalla
For Purchase Ledger Use
Position:
Multistore Unit Manager Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
Medical Expense
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Office Transportation Other Notes
Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Amount (QAR) Goods Supplies Expenses Total
Expenses
(QAR or FX)
QAR
1/5/2023 457720 Treatment - Radiofrequency Ablation QAR 9,000.00 1.0000 9,000.00 Medical expense 9,000.00
1/5/2023 457720 Trearment - 1 Lim High Ligations & stripping - veins QAR 5,000.00 1.0000 5,000.00 Medical expense 5,000.00
1/7/2023 8001143 Pharmacy QAR 17.00 1.0000 17.00 Medical expense 17.00

****************************** Nothing Follows ************

TOTAL 14,017.00 14,017.00 - - - - - 14,017.00

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Rachell Austria Hempisalla Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : 1/16/2023 included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name:
 Name:
Ye Min Aung
For Purchase Ledger Use
Position:
Shift Leader Expense Reimbursement Form Document Number
Payment:
Cash All expenses must match the statement/Receipts
Reason:
Medical Examination
Statement date
Company:
QA HMS Host

Enter amounts in the appropriate analysis column below

Amount Cost of Goods Office Transportation Other Notes
Amount Travel
Receipt Date Receipt Number Business Justification Currency Expensed Rate Supplies Expenses Total
(QAR) Expenses
(QAR or FX)
QAR
QR 1.0000 -
QR 1.0000 -
- -
- -
- -

TOTAL - - - - - - - -

I agree that the expenses listed above have been incurred by me Authorised By: Authorised By: Notes for Completion

and claimed in line with the Group Expense Policy Statement Date - Enter the expense date shown on the
statement or receipt
Signature: Signature: Receipt Number - Write the corresponding number on the
receipt to ensure it matches the statement - receipts should
Employee be in date order
Signature: Business Justification - Enter the reason and justification
for the expense in line with the Expenses policy.
Date : Date : Gross Amount - This is the total amount being claimed -
where appropriate. - This is the amount with the VAT
Date : included. The amount should be in the currency expensed.
Rate: Enter the FX rate if the receipt is in a foreign currency.
Use 1 for expenses in QAR
Name: Ahmet Cam Name: Deena Shalab Columns - Enter the amount in QAR into the appropriate
column to categorise the expense. Use the column Notes to
give explanation of items entered or need to be attributed or
recharged to a particular company.

Position: General Manager Position: Business Finance Manager

Petty cash custodian: Claim received by :

Sign: Sign:

Date: Date:

Name: Name: