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  • Form Klaim Benefit

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    Jonathan Reiner
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    This document is an employee benefit claim form for Brilio Ventura Indonesia. It requests information such as the employee's name, ID number, directorate, group, date, and patient status. It also includes fields to provide the amount, date, name of patient, and description of sickness for doctor visits, lab tests, medicines, glasses allowance, birth allowance, wedding gift, and death allowance. The form must be signed by the requesting employee, acknowledged by the head of the employee's group or division, and checked by HR communications and benefits.

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    Original Title

    FORM KLAIM BENEFIT

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    This document is an employee benefit claim form for Brilio Ventura Indonesia. It requests information such as the employee's name, ID number, directorate, group, date, and patient status. It also includes fields to provide the amount, date, name of patient, and description of sickness for doctor visits, lab tests, medicines, glasses allowance, birth allowance, wedding gift, and death allowance. The form must be signed by the requesting employee, acknowledged by the head of the employee's group or division, and checked by HR communications and benefits.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    5 views3 pages

    Form Klaim Benefit

    Uploaded by

    Jonathan Reiner
    This document is an employee benefit claim form for Brilio Ventura Indonesia. It requests information such as the employee's name, ID number, directorate, group, date, and patient status. It also includes fields to provide the amount, date, name of patient, and description of sickness for doctor visits, lab tests, medicines, glasses allowance, birth allowance, wedding gift, and death allowance. The form must be signed by the requesting employee, acknowledged by the head of the employee's group or division, and checked by HR communications and benefits.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 3

    BRILIO VENTURA INDONESIA

    EMPLOYEE BENEFIT CLAIM FORM

    HR-Operation.01-Form
    Medical
    NAME : _________________ DIRECTORAT : _________________
    NIK : _________________ GROUP : _________________
    DATE : _________________ PATIENT : Employee Wife Child
    STATUS : Permanent Contract

    HR-Operation.01-Form Medical
    AMOUNT (RP) DATE NAME OF DESCRIPTION OF SICKNESS
    PATIENT

    DOCTOR

    ADMIN FEE

    LABORATORIUM

    MEDICINES

    (must attach copy recep from


    doctor)

    GLASSES ALLOWANCE

    (permanent employee)

    BIRTH ALLOWANCE

    (please attach a certificate of


    birth from the hospital/clinic)

    WEDDING GIFT

    (please attach a marriage


    certificate)
    DIED ALLOWANCE

    (please attach a died


    certificate)

    TOTAL

    Requested by Acknowledged by (min. Checked by


    Group(Div)/Unit(Dept) Head/Dir) HR-Com.Ben

    (…………………) (…………………) (…………………)

    HR-Operation.01-Form Medical

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