LAMPIRAN ‘A”
LAMPIRAN ‘A”
KENYATAAN TUNTUTAN ELAUN PERJALANAN DALAM NEGERI
BAGI BULAN TAHUN
|MAKLUMAT PEGAWAI |
| | |
|NAMA (Huruf Besar) : | |
|NO. KAD PENGENALAN : | |
|JAWATAN : | |
|GRED / KATEGORI / | |
|[KUMPULAN (**)] | |
|NO. GAJI : | |
|NO. H/P & SAMB./* : | |
|NAMA & | |
|NO AKAUN BANK / | |
|CAWANGAN: | |
| | | |
| |GAJI : | |
| | | |
|PENDAPATAN (RM) |ELAUN-ELAUN : | |
| | | |
| |JUMLAH : | |
| |JENIS/MODEL : | |
|KENDERAAN |NO. PENDAFTARAN : | |
| |KUASA (C.C.) : | |
| |KELAS TUNTUTAN : |A/B/C/D/E/ (**) |
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| | |
|ALAMAT PEJABAT | |
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| | |
|ALAMAT RUMAH | |
| | |
(1)
|KENYATAAN TUNTUTAN |
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|Tarikh |Waktu |Tujuan / Tempat |RM |Jarak (KM) |
| |Bertolak |Sampai | | | |
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| | | |JUMLAH | | |
(2)
|TUNTUTAN ELAUN PERJALANAN KENDERAAN |
|BAGI : | | | | | | | |
| |500 KM PERTAMA |…… |KM |…… |SEN/KM: |RM |
| |501 – 1000 KM |…… |KM |…… |SEN/KM: |RM |
| |1000 – 1700 KM |…… |KM |…… |SEN/KM: |RM |
| |1701 KM SETERUSNYA |…… |KM |…… |SEN/KM: |RM |
| | | | | | | | |
| | | | | | |JUMLAH: |RM |
|TUNTUTAN TAMBANG PENGANGKUTAN AWAM |
|TEKSI |(RESIT : …………………………………………) | |RM |
| |(TANPA RESIT : …………………………) | | |
|BAS |(RESIT : …………………………………………) | |RM |
|KERETAPI |(RESIT : …………………………………………) | |RM |
|FERI |(RESIT : …………………………………………) | |RM |
|LAIN-LAIN : | | |RM |
| |JUMLAH: |RM |
|TUNTUTAN ELAUN MAKAN / ELAUN HARIAN |
| |X |ELAUN MAKAN SEBANYAK |RM |/HARI : |RM |
| |X |20% ELAUN MAKAN SEBANYAK |RM |/HARI : |RM |
| |X |40% ELAUN MAKAN SEBANYAK |RM |/HARI : |RM |
| |X |ELAUN HARIAN SEBANYAK |RM |/HARI : |RM |
| | | | |JUMLAH : |RM |
|TUNTUTAN BAYARAN SEWA HOTEL (BSH) / ELAUN LOJING |
| |X |BSH SEBANYAK |RM |/HARI : |RM |
|BAYARAN PERKHIDMATAN DAN CUKAI KERAJAAN : | | |
| |X |ELAUN LOJING SEBANYAK |RM |/HARI : |RM |
| | | | |JUMLAH : |RM |
(3)
|TUNTUTAN PELBAGAI |
|Tol [ Resit : |]: |RM |
|Tempat Letak Kereta [ Resit : |]: |RM |
|Dobi [ Resit : |]: |RM |
|Telefon, Teleks, Faks [ Resit : |]: |RM |
|Yuran Pendaftaran [ Resit : |]: |RM |
|Kerugian pertukaran matawang asing @ 3% | | |
|(Bagi Singapura, Selatan Thailand, Kalimantan | |RM |
|dan Brunei Darussalam sahaja) | | |
| JUMLAH | |RM |
|JUMLAH TUNTUTAN | : |RM |
|PENGAKUAN |
|Saya mengaku bahawa : | |
| | | |
|a) |Perjalanan pada tarikh-tarikh tersebut adalah benar dan telah dibuat atas urusan rasmi; | |
| | | |
|b) |Tuntutan ini dibuat mengikut kadar dan syarat seperti yang dinyatakan di bawah peraturan-peraturan | |
| |bagi pegawai bertugas rasmi dan / atau pegawai berkursus yang berkuatkuasa semasa ; | |
| | |
|c) |Perbelanjaan yang bertanda (*) berjumlah sebanyak RM |
| |telah sebenarnya dilakukan dan dibayar oleh saya; |
| | | |
|d) |Panggilan telefon sebanyak RM…………… dibuat atas urusan rasmi; dan | |
| | | |
|e) |Butir-butir seperti yang dinyatakan di atas adalah benar dan saya bertanggungjawab terhadapnya. | |
| |
|Tarikh : |
| |
| |
|…………………………… |
|(Tandatangan) |
(4)
|PENGESAHAN |
| |
|Adalah disahkan bahawa perjalanan tersebut adalah atas urusan rasmi. |
| | |
|Tarikh : | |
| |……………………………………………. |
| |( Tandatangan ) |
| | |
| | |
| |…………………………………………… |
| |( Nama ) |
| | |
| | |
| |…………………………………………… |
| |( Jawatan ) |
| |b.p. Ketua Setiausaha / |
| |Pegawai-Pegwai |
|PENDAHULUAN DIRI ( JIKA ADA ) |
| | |
|Pendahuluan Diri Diberi |RM |
|Tolak : Tuntutan Sekarang | |
| | |
|Baki dituntut / Baki dibayar balik |RM |
Catatan:
(*) - jika pegawai memilih untuk menerima SSB
(**) – potong mana yang tidak berkenaan
(5)
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