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EXPENSE CLAIM EXPENSE ALLOCATION

Please attach receipts and tickets


Project Code T4 $ or %
o enclosed - -
o through e-mail - -
o not applicable - -
- -

Name:

DATE Receipt
LOCATION DETAILS OF EXPENDITURE Currency AMOUNT RATE IDR
(d/m/y) No.

DATE (d/m/y)

s:\share\forms\expclaim.xls 08/09/2020
EXPENSE CLAIM EXPENSE ALLOCATION
Please attach receipts and tickets
Project Code T4 $ or %
o enclosed - -
o through e-mail - -
o not applicable - -
- -

Name:

DATE Receipt
LOCATION DETAILS OF EXPENDITURE Currency AMOUNT RATE IDR
(d/m/y) No.

Total this page


Total in Rp.
Less Advance
Balance (+/-)

s:\share\forms\expclaim.xls 08/09/2020

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