Business Travel Claim

BUSINESS TRIP CLAIM FORM

Name JENI PRAYITNO ID No. : X1901293
Position Surveyor
Department Planning
Home Base JAKARTA ( Cyber 2 )
ALLOWANCE
DATE
Destination Amount per day Duration Day(s) Total
From To
Bandung Jakarta Bandung 6 Rp 480,000.00
Rp80,000.00
Total Allowance to be claimed: Rp 480,000.00
EXPENSES
Destination
Transportation Date Purpose Total
From To
Sewa motor 09 - 14 Nov 2023 Bandung Hotel Site Rp 600,000.00
Transportation Kereta api 9-Nov-23 Bekasi Bekasi Bandung Rp 350,000.00
Transportation Kereta api 14-Nov-23 Bandung Bandung Bekasi Rp 350,000.00
Hotel 09 - 14 Nov 2023 Bandung Hotel Site Rp 2,000,000.00
Transportasi Grab/Gojek 9-Nov-23 Bekasi Stasiun Hotel Rp 250,000.00
Transportasi Grab/Gojek 14-Nov-23 Bandung Hotel Stasiun Rp 250,000.00

Total expenses to be claimed: Rp 3,800,000.00

Prepared by, Supervisor Approval Approved by, Acknowledged by,

(Jeni Prayitno) (Sofyan Maulana) (Yudo Satrio) (Lotus)

Submission date:_____________
Note: This form should be attached with BTA, Receipt (if any), & BOP (if any)

DGE BTR Form.xls

 APPLICATION FOR BUSINESS TRIP
PERMOHONAN PERJALANAN DINAS

Employee No. (ID) X1901293 Department Planning

Homebase Jakarta Project Name Bandung

Name / Nama Jeni Prayitno Hand Phone No. 81285351162

Position Surveyor Email Address (office & private) jeni.prayitno@fiberstar.co.id

Destination Purpose
Bandung survey site
Tujuan Keperluan
Departure & Arrival Date
Travelling Service
09-11-2023/14-11-2023
Kendaraan yang digunakan Periode perjalanan dinas

Please transfer to (for advance purpose only) :

Name of Employee Name of Bank & Branch Address Amount Transferred (Rp.) Bank Account No.

Jeni Prayitno BCA 4,280,000.00 5750404091

Acknowledged by
Applied by Approved by Received by
Diajukan oleh Disetujui oleh Diterima oleh
Diketahui oleh

(Jeni Prayitno) (Sofyan Maulana) (HR Fiberstar) (LOTUS)

DGE BTA Form.xls