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Title: Employee Expense Claim Form

Date: March 2015


Document Reference: OS5 v2.0

EMPLOYEE EXPENSE CLAIM FORM


NAME

DEPT/DIV/POSITION
Recruitment
EXPENSE CATEGORY MARK WITH AN 'X' (ONE X PER ROW ONLY)

DATE

Details of expense (e.g. destination/purpose, business mileage details,


business entertainment details (who), sundries details, recharge details)

Business
mileage

Per diem

Airport
Taxi
Taxi
Tax
Singapore Indonesia

Hotel
(lodging)

Meals
(self)

Personal
incidental
expenses

Business
Phone
entertaini
calls
ng

Month of claim
Y/N boxes

Other
sundry
exp

Mar-15
Claimed cost

Sales tax

VAT/GST/
Cost from Rechar
sales tax
advance?
ge
(in local
(Y/N)
(Y/N)
currency)

Cost in local
currency

Exchange rate

Total
Advances:

Currency 1

Currency 2 Exch rate 1 Exch rate 2

Cost in home
currency

Rp0.00

In home
currency

Advanced
Spent as above

TICKET #

AMOUN
T

Returned
Less advance outstanding (A)

Outstanding

I claim the above expenses in line with the company's travel & expenses policy:

Total payable

Claimant's signature:

Date

Authorised name & signature:

Date

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