Expense Form For Company January Sample

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EXPENSES CLAIM

Date: 09/01/24
From Expense No : 018/Exp-Rep/Jacob/01/24
Name : Jacob Colston
Original amount
No Description of Expenses Curr. Rate Amount in IDR Reff
1 Tol idr 10.500
2 Tol idr 17.000
3 Tol idr 10.500
4 Tol idr 8.000
5 Tol idr 8.000
6 Gas idr 200.000
7 Tol idr 8.000
8 Tol idr 4.000
9 Tol idr 8.000
10 Tol idr 10.500
11 Tol idr 8.000
12 Tol idr 8.000
13 Tol idr 8.000
14 Tol idr 8.000
15 Tol idr 8.000
16 Tol idr 8.000
17 Tol idr 8.000
18 Tol idr 24.500
19 Tol idr 12.500
20 Tol idr 8.000
21 Tol idr 17.000
22 Tol idr 12.500
23 Tol idr 8.000
24 Tol idr 17.000
25 Tol idr 8.000
26 Tol idr 8.000
27 Tol idr 10.500
28 Tol idr 17.000
29 Tol idr 10.500
30 Tol idr 17.000
31 Tol 8.000
32 Tol idr 10.500
33 Tol idr 10.500
34 Tol idr 8.000
35 Tol idr 24.000
36 Tol idr 10.500
37 Tol idr 8.000
38 Tol idr 17.000
39 Tol idr 17.000
40 Tol idr 8.000
41 Tol idr 8.000
42 Tol idr 25.500
43 Tol idr 8.000
44 Tol idr 24.000
45 Tol idr 10.500
46 Tol idr 8.000
47 Tol idr 7.000
48 Tol idr 10.500
49 Tol idr 47.000
50 Tol idr 7.500
TOTAL EXPENSES 788.500
-/- TOTAL ADVANCE
OVER / (LESS PAYMENT)

Acknowledge by: Approved by: Proposed by:

[Mr Paul Colston] (Mr Jason Kennedy) Employee Name

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