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PAYMENT REQUEST

"TAJWID CINTA"
-- OTHER --
NAME : NO :

TEAM : DATE :
--- MUST BE ATTACHED BY RECEIPT FOR EACH LINE ITEM ---

STATUS *)
NO. TYPE OF EXPENDITURE DAY QTY PRICE/QTY AMOUNT PAJAK TOTAL NETT NOTE
C UC R

1 -

2 -

3 -

4 -

TOTAL -

Status *) C = Consumable
ABOVE AMOUNT TRANSFER TO :
UC = Unconsumable :
BENEFICIARY NAME
R = Rental :
BANK NAME
:
A/C NUMBER

Prepared by, Verified by, Approved By, NOTE :

Taufik Hidayat Eka Jimmy Lalwani

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