Update February 2012

*TOTAL

CLAIM FORM FOR PART TIME: TUTOR / GRADER / DEMONSTRATOR

KULLIYYAH OF ENGINEERING
INTERNATIONAL ISLAMIC UNIVERSITI MALAYSIA
MONTH: ___________20___
NAME
HOME ADDRESS

TEL NO
INCOME TAX NO
BANK ACCOUNT NO
OTHERS

POSITION

: ____________________________________________________________________________
: ____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
: __________________________________ I/C /PASSPORT NO : ____________________
: __________________________________ *EPF NO
: ____________________
:__________________________________ BMMB [ ] BIMB [ ] (Bank Muamalat or Bank Islam only)
: RESEARCH ASST. (RA) [
] MONTHLY PAY : RM _________
: PARTIAL SCHOLAR
[
]
: FULL SCHOLAR
[
]

COURSE CODE AND TITLE

SECT

RM

LECTURER
SIGNATURE

LECTURER NAME
/ STAMP

TOTAL
*NOTE: EPF Number is compulsory for Malaysian citizen
REQUESTED BY

APPROVED BY

I HERE BY CERTIFY THAT THE ABOVE CLAIM ARE TRUE

HEAD OF DEPARTMENT

SIGNATURE __________________________

SIGNATURE ______________________

NAME

NAME

___________________________

______________________

OFFICIAL STAMP
Rules and Regulation:
1. COMPULSORY: All claims form must be written with pen (blue / black) only.
2. COMPULSORY: All claims form must be attached with VALID OFFER LETTER.
3. A completed claim form should be submitted 1st day of the following month to the FINANCE UNIT OF KOE.
4. Any rejected claim will be under responsibility of Personal assistant (P.A) to inform the applicant.
5. Payment for claims (with EPF number) will be made on 15th and claim (without EPF number) will be made on last day of the month.
6. All students are only eligible to apply for a maximum of 3 SECTIONS ONLY.
7. Claims for all sections (3 sections only) should be made in ONE FORM ONLY.

Update February 2012

Staff No.

**Total
KULLIYYAH OF ENGINEERING
INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA
PART TIME: LECTURER / TUTOR / DEMONSTRATOR
(COMPULSORY: Kindly Attach the Offer Letter)
MONTH: _____________ 20__

NAME
HOME ADDRESS

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
TEL. NO. (RES)
____________________________________________________________________
I/C or PASSPORT NO.
____________________________________________________________________
INCOMETAX NO.
_________________________
*EPF NO.
______________________
*NOTE : Claim Above RM5 / Hour *EPF Number is Compulsory for Malaysian Citizen
BANK ACCOUNT NO.
________________________________________
BMMB
BIMB
(Bank Muamalat or Bank Islam only)
PENALTY RM 50.00 will be charged if FALSE BANK ACCOUNT NO. given
SUBJECT
________________________________________ RATE PER / HR :

A. TOTAL HOURS

DATE

TOTAL

TIME

TOTAL HOURS
HOURS

MILEAGE
TO & FROM

RM

Update February 2012

MILEAGE
FROM

___________________________

TO

____________________________________

TOTAL ( KM______________________________________________________
)
TYPE OF CAR
________________________________

Kilometer

Car Cc > 1500

55
51
48
39
38
36
35
33
33
32

First 500
150 after 500
150 after 650
150 after 800
150 after 950
150 after 1100
150 after 1250
150 after 1400
150 after 1550
For every km after 1700

CC

( TO & FROM )

______________________________

Cents Per Kilometer

Car Cc > 1300
41
37
35
33
32
32
32
31
31
30

Car Cc < 1300

35
31
29
29
27
27
27
26
26
24

Total
Amount

Total

I HEREBY CERTIFY THAT THE ABOVE CLAIMS ARE TRUE

SIGNATURE

__________________________________

NAME

__________________________________

RECOMMENDED BY ( LECTURER OF THE COURSES )

SIGNATURE

__________________________________

NAME

__________________________________
( OFFICIAL STAMP )

APPROVED BY
HEAD OF DEPARTMENT
SIGNATURE

__________________________________

NAME

__________________________________
( OFFICIAL STAMP )

Rules and Regulation:

1.
2.
3.
4.
5.

COMPULSORY: All claims form must be written with pen (blue / black) only.
COMPULSORY: All claims form must be attached with VALID OFFER LETTER.
A completed claim form should be submitted 1st day of the following month to the FINANCE UNIT OF KOE.
Any rejected claim will be under responsibility of Personal assistant (P.A) to inform the applicant.
Payment for claims (with EPF number) will be made on 15th and claim (without EPF number) will be made on last day of the month.