KENYATAAN TUNTUTAN ELAUN PERJALAN DALAM NEGERI
Pekeliling Perbendaharaan Malaysia WP 1.4/2013 Lampiran C
LAMPIRAN C
KENYATAAN TUNTUTAN ELAUN PERJALANAN DALAM NEGERI
|BAGI BULAN | TAHUN |
| A: MAKLUMAT PEGAWAI |
|Nama : |
|No. Kad Pengenalan : No. Gaji : |
|Gred / Kategori / Kumpulan (*): |
|Jawatan: |
|Pendapatan (RM) | Gaji + Elaun Memangku (jika ada): |
| |Elaun lain : |
| |JUMLAH: |
|Kenderaan | Jenis/Model: |No. Pendaftaran: |
| |Kuasa (cc): |Kelas Tuntutan: |
| |Kelulusan: |Km Diluluskan: |
|Alamat Pejabat | |
|(Unit / Wad) | |
|Email | |No Telefon : |
|Alamat Rumah | |Alamat Lojing : |
| | | |
|Nama Bank | |
|No Akaun | |
|B: KENYATAAN TUNTUTAN |
| |Waktu |Tujuan |Jarak |
|Tarikh | | |(Km) |
| |Bertolak |Sampai | | |
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|C: TUNTUTAN ELAUN PERJALANAN KENDERAAN |
| Bagi: | | | |
| | | | |
|500km pertama |km x |sen/km |RM |
|501 km sehingga 1000 km | km x |sen/km |RM |
|1001 km sehingga 1700 km | km x |sen/km |RM |
|1701 km dan seterusnya | km x |sen/km |RM |
| | | JUMLAH : |RM |
| | | | |
|D: TUNTUTAN TAMBANG PENGANGKUTAN & PENDAFTARAN KURSUS |
|Kapal Terbang *Resit : |RM |
|Teksi / Bas *Resit : |RM |
|Keretapi / Komuter *Resit : |RM |
|Feri *Resit : |RM |
|Tol / Parking / Lain-lain *Resit : |RM |
|Yuran Pendaftaran Kursus *Resit : |RM |
| JUMLAH : |RM |
| E: TUNTUTAN ELAUN MAKAN & ELAUN HARIAN |
| (hari ) X Elaun makan sebanyak RM |RM |
| (hari ) X Elaun harian sebanyak RM |RM |
| JUMLAH : |RM |
|F: TUNTUTAN BAYARAN SEWA HOTEL (BSH) / ELAUN LOJING |
| (hari) X Bayaran Sewa Hotel (T/R) sebanyak RM |RM |
|(hari) X Bayaran Sewa Hotel (K) sebanyak RM |RM |
| Bayaran perkhidmatan & cukai kerajaan |RM |
| (hari) X Elaun Lojing sebanyak |RM |
| JUMLAH : |RM |
|Jumlah Tuntutan Keseluruhan |RM |
|G: PENGAKUAN |
|Perjalanan pada tarikh-tarikh tersebut adalah benar dan telah dibuat atas urusan |
|rasmi. |
|Tuntutan ini dibuat mengikut kadar dan syarat seperti yang dinyatakan di bawah |
|peraturan-peraturan bagi pegawai bertugas resmi dan/atau pegawai |
|berkursus yang berkuatkuasa semasa |
|Perbelanjaan bertanda * sebanyak RM………….telah sebenar dilakukan dan dibayar oleh saya. |
|d) Panggilan telefon sebanyak RM............dibuat atas urusan rasmi dan |
| |
|Perkara-perkara yang dinyatakan di atas adalah benar dan saya bertanggung jawab terhadapnya. |
|Tarikh: |Tandatangan: |
| |Cop Jawatan: |
|H: PENGESAHAN |
|Adalah disahkan bahawa perjalanan tersebut adalah atas urusan rasmi. |
|Tarikh: |Tandatangan: |
| |Cop Nama & Jawatan: |
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