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Staff expenses claim for the month of Name : Department :

( as stated in your bank a/c )

EXPENSES CLAIM FORM


Place/Location MILEAGE Label
ENTERTAIN
DATE DESCRIPTION Receipt TEL MEDICAL ERP/ Toll PARKING OTHERS TOTAL
From To KM COST MENT
Number
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL : 0 0 0 0 0 0 0 0

Claimant's Signature Approved By : Country Manager Approved By : HR Approved By : MD

______________________ ______________________
Amounts claimed should be provided with original invoices or receipts and with self-explantory notes.
In respect of entertainment expenses, please provide details at back of form.

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