CRS1

CLAIM FORM FOR TRAVELLING/ TRAINING

Important :-

1. All claims must be submitted to HRS Department within 3 calendar months from the month the expenses
were incurred. (e.g. Expenses paid in January must be submitted to HRS Dept on or before March 31).
For claims such as Club Subscription and telephone, the claims must also be made within 3 calendar months
supported by original/copy of statement/bill. (e.g. Rental or Fees for the month of January must be submitted
to HRS Dept. on or before March 31).
2. Original receipts/bills are to be enclosed.
3. Acceptance of Claims are subject to existing Collective Agreements and Terms & Conditions of the Bank.
4. Claims must be verified and approved by the appropriate authorities.
5. Separate form to be used for each type of claim.

Note :-

Bank will not be liable to pay for any interest charged for late payment/settlement of bills by staff to any
organization/company.

TYPE OF CLAIMS

Traveling

Training

* Please ( / ) whichever is applicable.

PARTICULARS OF CLAIMANT
Full Name
: ROSLI BIN AHMAD
Staff No
: 135345
Personal Grade (PG)
Dept/Branch
: AREA MANAGER'S OFFICE
Cost Centre
Contact No
: 019-3881692
The claims reimbursement amount will be automatically credited into Staff Salary Crediting Account.
NATURE OF CLAIM
No

: PG 3
: RCN 20

(The Subsistence Allowance amount will be generated by system based on the date and time given)

Details/Purposes

i Bi Mthly Checking @ Tg Karang

ii BOM RQ Checking @ Jenjarom
iii BOM RQ Checking @ Klang 2

From
Date
25/08/2010
21/09/2010
22/09/2010

To
Time
8.45AM
8.45AM
8.45AM

Date
25/08/2010
21/09/2010
22/09/2010

Time
5.45PM
5.45PM
5.45PM

Day (s)
1 DAY
1 DAY
1 DAY

MODE OF TRAVEL (determined by Head of Division/ Department/RCB/Branch)

i) Public Transport
Taxi
Train
ii)

RM
RM

Plane
RM
Others
RM
(Pls specify :

RM
)

X Car
Motorcycle
Distance (in radius) from base / house to the destination, whichever is nearer
Place :

i)
ii)
iii)

Tg Karang
Jenjarom
Klang 2

Mileage :

130
100
60

Total :

@ RM0.70 / RM0.60 / RM0.55 / RM0.50 / RM0.45 / RM0.35 X

203

km
km
km

km

RM 203

iii) Parking/Toll : ( For Toll, please specify : Touch & Go, Smart Tag & etc )

RM

SUBSISTENCE ALLOWANCE/TRAINING ALLOWANCE

i)

Beyond *15 km / 40 km WITH 4 hours work or more

and NO overnight stay

ii)

Beyond *15 km / 40 km WITH overnight stay

- hotel provided
- hotel not provided

RM

20

RM
RM

x
x

day(s)

RM 40

day(s)
day(s)

RM
RM

*Note : Delete whichever is not applicable

15 km applies to unionised staff only
40 km applies to non-unionised staff only

iii) Day of travelling to venue

Date :

Time

am / pm

RM

iv) Day of return to normal place of work

Date :

Time

am / pm

RM

OTHERS (hotel accommodation , airport tax , laundry & etc)

i)
ii)

RM
RM
Grand Total

I hereby declare the information is true and

correct and if any of the information is found
to be not true, disciplinary action maybe taken
against me.

RM 243

DECLARATION BY CLAIMANT
FOR EXPENSES CHARGED USING CREDIT CARD
Credit Card No :
RHB Card :

* Non RHB Card :

Please ( / ) whichever is applicable.

*Justification for using Non RHB Card :Date :

11/10/2010
VERIFIED BY IMMEDIATE SUPERIOR

Name :
Date :

APPROVED BY HEAD OF DIV/DEPT/REGIONAL/BRANCH MANAGER

Name
:
Date
:
Comment (if any) :