EXPENSE CLAIM FORM

Name : Aliarta Murdana

Purpose :

Expense Amount (Currency)

Date Expense Explanation
Code Currency
07-Sep-17 Rembesan parkir dikokas
06-Sep-17 Rembesan parkir dikokas
02-Sep-17 Rembesan parkir dikokas
31-Aug-17 Rembesan parkir dikokas
29-Aug-17 Rembesan parkir dikokas
27-Aug-17 Rembesan parkir dikokas
26-Aug-17 Rembesan parkir dikokas
25-Aug-17 Rembesan parkir dikokas
24-Aug-17 Rembesan parkir dikokas
22-Aug-17 Rembesan parkir dikokas
21-Aug-17 Rembesan parkir dikokas
20-Aug-17 Rembesan parkir dikokas
15-Aug-17 Rembesan parkir dikokas
14-Aug-17 Rembesan parkir dikokas
12-Aug-17 Rembesan parkir dikokas
11-Aug-17 Rembesan parkir dikokas
11-Aug-17 Rembesan parkir dikokas
Total Expenses
Cash Advanced
Total Claimed / (Returned)
*Attach all receipts to expense forms. COO or CFO signature required on all expenses xceededing USD300.00

Signature :

Signature :
Signature :
FORM

Business Unit : Fullfilment Officer

Date : 08-Sep-17

Amount (Currency) Ex. Rate Amount

Amount (IDR)
Rp 37,000.00
Rp 25,000.00
Rp 29,000.00
Rp 33,000.00
Rp 21,000.00
Rp 21,000.00
Rp 17,000.00
Rp 41,000.00
Rp 37,000.00
Rp 33,000.00
Rp 33,000.00
Rp 21,000.00
Rp 29,000.00
Rp 33,000.00
Rp 21,000.00
Rp 29,000.00
Rp 4,000.00
Rp 464,000.00
Rp 464,000.00
Rp 464,000.00
D300.00

EXPENSES CODE
Office Supplies 413
Small Equipment 415
Computer Supplies 470
Postage 471
Printing & Stationery 472
Subscriptions 473
Miscellaneous Expenses 475
Repairs and Maintenance 476
Bank Fees 477
Telephone & Mobile 430
Internet 431
Flights 450
Hotels 451
Meals (Travel) 452
Taxis and Ground Transportation 453
Other Travel (Toll,Mileage,Fuel) 454
Messenger Service 455
Car Park Expenses 456
Warehouse Supplies 423
Customer/Investor Entertainment 462
Other shipping costs 216
aDelivery Costs 217
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