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PERSATUAN BULAN SABIT MERAH MALAYSIA

CAWANGAN NEGERI SEMBILAN

TRAVEL CLAIM FORM

Form No .................................. Date: 13 APRIL 2009

Name of Claimant: ARIF FADZILAH BIN MOHD SAID (700410-05-5125)

Rank held: PEGAWAI LATIHAN Branch / District Level: CABANG JEMPOL

In respect of: PERKHEMAHAN SUKARELAWAN KEBANGSAAN BSMM 2009

Meeting / Courses

Held at KEDA RESORT BENDANG MAN, SIK, KEDAH.

on 1 HINGGA 4 APRIL 2009 (Date / Dates)

CLAIM

1. Use of own car @ 2 cents per km.

597 km X 20 cents X 2 days $ 238.80

2. Taxi Fares: $ ____________

3. Meals: ( Maximum $ 5.00 per meal or $ 15.00 per day) $ 30.00

4. Accommodation (attach receipt) provided hospitality


Not provided for and not exceeding $35.00 per night. $ ____________
5. Miscellaneous (Give details and attach receipts)
i. Toll fees $ 54.90 X 2
$ 109.80

Total Claim: $ 378.60

Approved by: Submitted by:

…………………………………….. ………………………………………..
( Signature ) Signature of Claimant
Branch Chairman / Secretary / Director

Date: 13.04.2009

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