PAGE 1HRD/IKRAM/CLAIM/MILEAGE/003/15PROTASCO GROUP OF COMPANIESSTAFF C L A I M2015NAME:KHAIRON HAFIZAN BIN MOHD TAHUDINGRADE: E5STAFF NO.:KIN00786DEPARTMENT:LABORATORYDESIGNATION:LAB EXECUTIVEDIVISION:KUMPULAN IKRAM SDN.BHDVEHICLETYPE / MODEL:REGISTRATION NO.:Residential Address:KUMPULAN IKRAM SDN BHD (IKRAM SELATAN), NO.2 & 2-01, JALAN IMPIAN SKUDAI 1, TAMAN IMPIAN SKUDAI,( In Full )81300 SKUDAI, JOHOR.DATETIMEJOURNEYPURPOSE / PROJECTDISTANCE (KM)FROMTOORIGINDESTINATION03.03.20158.30AM5.30PMISKYPJ KULAIFDT100.0011.03.20158.30AM5.30PMISDESARUPROBA MACKHINTOSH163.0016.03.20158.30AM5.30PMISPENGGELI TIMURPROBA MACKHINTOSH108.0018.03.20158.30AM5.30PMISBATU PAHATGENOVEN TEST240.0026.03.20158.30AM5.30PMISTAI HONGFDT123.0028.03.20158.30AM5.30PMISTAI HONGCBR TEST123.00TOTAL0.00MILEAGE CLAIMSFIRST 400:kmx0.60cent / kmRM0.00NEXT 100:kmx0.50cent / kmRM0.00*Motorcycle:26.00kmx0.20cent / kmRM5.20(A) TOTALRM5.20

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PAGE 2TRAVELLING CLAIMSSupporting Documents ReferenceClaim Amount (RM)Allowed GST (RM)Payable Amount (RM)Flight(Ref. No : )RMRMRM0.00Parking(Ref. No : )RMRMRM0.00Car Rental(Ref. No : )RMRMRM0.00Petrol(Ref. No : )RMRMRM0.00TOTALSub-total0.000.000.00Blocked GST (RM)Bus/Taxi/Ferry(Ref. No : )RMRM0.00Toll(Ref. No : )RMRM0.00Vehicle Maintenance(Ref. No : )RMRMRM0.00TOTALSub-total0.000.000.00(B)TotalRM0.00MEAL ALLOWANCE / SUBSISTANCE ALLOWANCEPeninsular Malaysia6day (s)x RM22.50Meal AllowanceRM135.00Sabah/Sarawakday (s)x RMMeal AllowanceRM0.00Overseasday (s)x RMMeal AllowanceRM0.00( C )TotalRM135.00LODGING / ACCOMODATIONClaim Amount (RM)Allowed GST (RM)Payable Amount (RM)Peninsular MalaysiaReceipts No:RM42.00RMRM42.00Sabah/SarawakReceipts No:RMRMRM0.00OverseasReceipts No:RMRMRM0.00Without Receipts(Refer declaration)RMRM0.00TOTAL42.000.0042.00Note: Please attach separate listing if more than 1 receipt.) ( D )TotalRM42.00

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PAGE 3ENTERTAINMENTClaim Amount (RM)Allowed GST (RM)Payable Amount (RM)Existing Client / StaffReceipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Sub-total0.000.000.00Claim Amount (RM)Blocked GST (RM)Payable Amount (RM)Potential ClientReceipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Receipt No.:RMRMRM0.00Sub-total0.000.000.00( E )TotalRM0.00MISCELLANEOUSClaim Amount (RM)Allowed GST (RM)Payable Amount (RM)Receipts No :RMRMRM0.00Receipts No :RMRMRM0.00Receipts No :RMRMRM0.00Sub-total0.000.000.00( F )TotalRM0.00GRAND TOTAL ( A ) + ( B ) + ( C ) + ( D ) + ( E ) + ( F ) :RM182.20I hereby certify that the above claims are true and correctly stated and are made in performance of my duty on behalf of the Company.Claimed by :Verified by :Approved / Not Approved by :Date :Date :Head of DepartmentDate :Checked by :Approved / Not Approved by :HR DepartmentExecutive Vice Chairman / Managing DirectorDate :Date :Notes :1. All claims where necessary must be supported with original receipts or bills / signed and verified with approval on each supporting documents.2. The completed form must be submitted to HR Department by 10th of each month.

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CLAIM WITHOUT RECEIPTPROTASCO GROUP OF COMPANIESDECLARATION FOR EXPENSES WITHOUT RECEIPTDATEJOURNEYPURPOSE/PROJECTTYPE OF CLAIM / EXPENSESTOTAL (RM)FROMTOTOTAL (RM)Note :I hereby declare that the above claim is for Company's official business / duties only.I have ealier paid the above claim.Name :(Signature)Staff ID :Date :I hereby certify that the above claim(s) are true to the best of my knowledge.Name :(Head of Department/Division)(Signature)Date :