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Lampiran C Borang Tuntutan Elaun Perjalanan Dalam LAMPIRAN C BORANG TUNTUTAN ELAUN PERJALANAN DALAM NEGERI BAGI BULAN JANUARI / TAHUN 2020 0$./80$73(*$:$, Nama (Huruf Besar) : SABRINA BINTI SULAIMAN No. Kad Pengenalan : XXXXXX-XX-XXXX Jawatan : KETUA PEMBANTU TADBIR (BAYARAN) Gred : N22 No. 3HNHUMD : XXXX No. Akaun Bank : XXXXXXXXXXXXXX Nama / Alamat Bank : CIMB BANK BERHAD, JALAN CONLAY, 50480 KUALA LUMPUR Gaji : 1,200.00 H Pendapatan (RM) Elaun-elaun : 450.00 Jumlah : 1,650.00OHO Jenis/ ModelModM el : PROTON/PERSONA 1.6 Kenderaan TO No.No. PendaftaranPendaftarafta an : PKH4235 LEMBAGA PERTUBUHANNTOHNT PELADANG, Alamat Pejabat MENARA LPP, NO. 20, JALAN SULTAN SALAHUDDIN, 50480OON KUALA LUMPUR NO. XX, JALAN SEROJA X, Alamat Rumah Pegawai TAMAN BANDAR UTARA, CONCOC70450 SEREMBAN, NEGERI SEMBILAN. Alamat Rumah Pemandu/ Juruiring/ Rapat/ Pengawal Peribadi* Alamat Rumah Majikan (Anggota Pentadbiran/Pegawai Pengurusan Tertinggi Gred JUSA B dan ke atas)* *Diisi oleh pegawai yang layak membuat tuntutan Perjalanan di bawah PP WP1.6. .(1<$7$$1781787$1 :DNWX 7DULNK -DUDN %XWLUDQ7XQWXWDQ %HUWRODN 6DPSDL NP 6.1.2020 8.00 PAGI 4.30 PETANG Dari Menara LPP ke Jeti Kuala Perlis 492 Menaiki kenderaan sendiri menghadiri Task Force Sistem Century Tol - RM80.00 Dari Jeti Kuala Perlis ke IPP Langkawi , Kedah. Feri - RM35.00 (resit no. 101) Elaun Makan - Pagi 20% = RM8.00 T.Hari 40% =RM16.00 Makan malam disediakan Bermalam di IPP Langkawi - RM180.00 (Resit IPP : 00101) 7.1.2020 9.00 PAGI 5.00 PETANG Di IPP Langkawi menghadiri Task Force System Century. Bermalam di IPP Langkawi - RM 180.00. (Resit Hotel - 00101) 8.1.2020 9.00 PAGI 12.00 T.HARI Di IPP Langkawi ke menghadiri Task Force Sistem Century 2.00 PETANG 10.30Malam Perjalanan pulang dari IPP Langkawi ke Jeti Kuala Perlis - Feri RM35.00 (resit no. 102). Dari Jeti Kuala Perlis menaiki kenderaan sendiri pulang ke rumah. 492 TOL - RM80.00 Parking - RM 15.00 Elaun Harian : RM20.00 ON CONTOHC -XPODK 984.00 .(1<$7$$1781787$1 :DNWX 7DULNK -DUDN %XWLUDQ7XQWXWDQ %HUWRODN 6DPSDL NP 334 15.1.2020 2.00 PETANG 6.00 PETANG Dari menara LPP ke Hotel Avenue, Johor Bahru. Menaiki kenderaan sendiri. Menghadiri Mesyuarat Penilaian Sebutharga Tol : RM60.00 Parkir : RM15.00 Elaun makan : T.hari 40% - RM16.00 Hotel : RM 180.00 (Resit Hotel - 9612) 16.1.2020 9.00 PAGI 12.00 T.HARI Dari Hotel Avenue Johor Bahru bertolak ke LPP Johor Bahru. 10 Menaiki Kenderaan Sendiri Menghadiri Mesyuarat Penilaian Sebutharga. 2.00 PETANG 7.00 MALAM Dari LPP Johor Bahru pulang ke rumah. 289 Tol : RM40.00 ON CONTOHC -XPODK 633.00 1,617.00 .(1<$7$$1781787$1 :DNWX 7DULNK -DUDN %XWLUDQ7XQWXWDQ %HUWRODN 6DPSDL NP ON CONTOHC -XPODK 1,617.00 .(1<$7$$1781787$1 :DNWX 7DULNK -DUDN %XWLUDQ7XQWXWDQ %HUWRODN 6DPSDL NP ON CONTOHC -XPODK 1,617.00 .(1<$7$$1781787$1 :DNWX 7DULNK -DUDN %XWLUDQ7XQWXWDQ %HUWRODN 6DPSDL NP ON CONTOHC -XPODK 1,617.00 Catatan: *Butiran tuntutan: Pegawai perlu menyatakan dengan jelas butiran tuntutan seperti perincian berikut: 1. Tempat bertolak dari mana; 2. Destinasi yang dituju; 3. Tujuan perjalanan; 4. Caj/bayaran parkir sekiranya ada; 5. Caj/bayaran tol sekiranya ada; 6. Elaun makan/harian sekiranya ada; 7. Tuntutan hotel/lojing sekiranya ada; dan 8. Lain-lain tuntutan sekiranya ada. 781787$1(/$813(5-$/$1$1.(1'(5$$1 .LUDDQ.LORPHWHU -DUDN .DGDU6HNLORPHWHU -XPODK(50) 500 km pertama 500.00 RM 0.85 sen/km 425.00 501 km dan seterusnya 1117.00 RM 0.75 sen/km 837.75 -XPODK 1,262.75 781787$17$0%$1*3(1*$1*.87$1$:$0 Teksi/Kereta Sewa [Resit …...……………..….………………….………………………….............] RM Bas [Resit .…………..…………..…………….………………………..……....................................] RM Kereta Api [Resit …………..…….………………………………………………..................................]...................... RM Feri [ Resit …………..…….……………………………………………...........................................]101, 102 …............. ........................ RM 70.00 Lain-Lain [Resit ……………………………………………………………………………………….…………………………………………… H ] RM OH-XPODK 50 70.00 781787$1(/$810$.$1(/$81+$5,$1$5,$5,$11 781787$1(/$810$.$1(/$81+$5,$17817 6(0(1$1-81*0$/$<6,$ $ TOT 6$%$+6$5$:$./$%8$1 Sarapan Pagi 1 .DGDU(ODXQ.DGDU(ODXQ.DGDU(OD Sarapan Pagi 0 .DGDU(ODXQ 40.00 NTN 65.00 Makan Tengah Hari 2 ONO Makan Tengah Hari Makan Malam Makan Malam CONTOHCCO0 RM 40.00 RM 0.00 Elaun Harian Elaun Harian 1 RM 20.00 RM 0.00 -XPODK 50 60.00-XPODK 50 0.00 781787$1%$<$5$16(:$+27(/ %6+ 781787$1%$<$5$16(:$+27(/ %6+ (/$81/2-,1* 6(0(1$1-81*0$/$<6,$ (/$81/2-,1* 6$%$+6$5$:$./$%8$1 2 ………………..x BSH sebanyak RM 360.00 ……….............. x BSH sebanyak RM 0.00 RM ................180.00.......... /hari. RM ……………………./hari. (Termasuk Bayaran Perkhidmatan (Termasuk Bayaran Perkhidmatan & Cukai Perkhidmatan) & Cukai Perkhidmatan) [Resit ………………………………00101 ] [Resit ………………………….......] RM ………………..x1 BSH sebanyak RM 180.00 ……….............. x BSH sebanyak 0.00 RM ................180.00.......... /hari. RM ……………………./hari. (Termasuk Bayaran Perkhidmatan (Termasuk Bayaranara Perkhidmatan & Cukai Perkhidmatan) & Cukai Perkhidmatan)hidmatanmatan [Resit ………………………………9612 ] [Resit ………………………………………………………....]…………………… RM ………………..x BSH sebanyak RM 0.00 ………..............…….............. x BSH sebanyak 0.00 RM .......................... /hari. RM ………………………………./hari. O (Termasuk Bayaran Perkhidmatan (Termasuk(TermasTerm Bayaran Perkhidmatan & Cukai Perkhidmatan) & CuCukai Perkhidmatan) [Resit ……………………………… ] NT[Resit ……………………………....] ………………..x BSHH sebanyakse RMONO 0.00 ……….............. x BSH sebanyak RM 0.00 RM .......................... /hari.hari.ari. RM ……………………./hari. (Termasuk Bayaran Perkhidmatandmatandmata (Termasuk Bayaran Perkhidmatan & Cukai Perkhidmatan) CONTOHCO & Cukai Perkhidmatan) [Resit ……………………………… ] [Resit ……………………………....] ………………..x BSH sebanyak RM 0.00 ……….............. x BSH sebanyak RM 0.00 RM .......................... /hari. RM ……………………./hari. (Termasuk Bayaran Perkhidmatan (Termasuk Bayaran Perkhidmatan & Cukai Perkhidmatan) & Cukai Perkhidmatan) [Resit ……………………………… ] [Resit ……………………………....] 781787$1%$<$5$16(:$+27(/ %6+ 781787$1%$<$5$16(:$+27(/ %6+ (/$81/2-,1* 6(0(1$1-81*0$/$<6,$ (/$81/2-,1* 6$%$+6$5$:$./$%8$1 ……….............. x BSH sebanyak RM 0.00 ……….............. x BSH sebanyak RM 0.00 RM ……………………./hari. RM ……………………./hari. (Termasuk Bayaran Perkhidmatan (Termasuk Bayaran Perkhidmatan & Cukai Perkhidmatan) & Cukai Perkhidmatan) [Resit ………………………….......] [Resit ………………………….......] ……….............. x BSH sebanyak RM0.00 ……….............. x BSH sebanyak RM 0.00 RM ……………………./hari. RM ……………………./hari. (Termasuk Bayaran Perkhidmatan (Termasuk Bayaranarara Perkhidmatan & Cukai Perkhidmatan) & Cukai Perkhidmatan)hidmatan [Resit ………………………….......] [Resit ……………………………....]…………………………………………… ……….............. x BSH sebanyak RM 0.00 ………..............……….……… ............... x BSH sebanyak RM 0.00 RM ……………………./hari. RM ……………………./hari.…………… (Termasuk Bayaran Perkhidmatan (Termasuk(Tere masukOH Bayaran Perkhidmatan & Cukai Perkhidmatan) & CukaiCuka Perkhidmatan) [Resit [Resit[R ……………………………....] …………………………………........] NT0.00 RM 0.00 ……….............. x Elaun LoLojingojing RM ……….............. x Elaun Lojing sebanyak RM ………….../hari.55.00 ./hari.i OONsebanyak RM …………./hari60.00 $ODPDW/RMLQJ: CONTOHCOC $ODPDW/RMLQJ: -XPODK 50 540.00-XPODK 50 0.00 x Sekiranya tuntutan lebih daripada bilangan ruangan yang ada, VLODJXQDNDQNHUWDVODPSLUDQ %(/$1-$3(/%$*$, Telefon, Telegram , Faks [Resit ………………………………………….……….............................] RM Pos [Resit ………………………………………………………………………....................................] RM Dobi [Resit ………………………………………………………….……………..................................] RM Cukai Lapangan Terbang [ Resit………………………………………………...................................] RM Lebihan Bagasi [ Resit…………………………………………………………....................................] RM Tempat Letak Kereta [Resit/Penyata Touch&Go/Lain-lain…………………………………… ………...] RM Tol [Resit/Penyata Touch&Go/RFID/Lain-lain……………………………………………………........]TOL no. xxxx, parking…………………… no. xxxxx RM 290.00 H-XPODK 50 290.00 OHO-80/$+781787$1-8 50 2,222.75 3(1*$.8$13(1*$.8$(1* TO Saya mengaku bahawa: NT (a) perjalanan pada tarikh-tarikh tersebuttersebut adalah benar dan telah dibuat atas urusan rasmi; (b) tuntutan ini dibuatdibibuau t mengikutmenggikuik tON kadar dan syarat seperti yang dinyatakan di bawah peraturan bertugas rasmi yyangang berkuatbeerkua kuasa dan/atau peraturan berkursus yang berkuat kuasa; (c) perbelanjaan yang tidakdCONTOH disokong dengan resit berjumlah sebanyak RM ……………………. telah sebenarnya dilakukan dan dibayar oleh saya; dan (d) semua butiran yang dinyatakan di atas adalah benar dan saya bertanggungjawab terhadapnya. Tarikh: …………………………….. …………………………………….. (Tandatangan Pemohon) 3(1*(6$+$1 Adalah disahkan bahawa perjalanan tersebut adalah atas urusan rasmi. Disemak Oleh : Ketua Pembantu Tadbir (Bahagian), Ketua Pembantu Tadbir (Kewangan) …………………………………….. Pembantu Tadbir Cawangan / PPK (Nama) Tarikh: …………………………….. …………………………………….. Tandatangan TimbalaQ Pengarah / Ketua Cawangan Tarikh: …………………………….. OHO …………………………………….. Tandatangan Ketua Pengarah / Pengarah Bahagian / Pengarah Negeri 3(1'$+8/8$1',5, -LND$GD 3( Pendahuluan Diri diberiberi O RM Tolak: Tuntutan sekarang COCONTOH RM Baki dituntut/Baki dibayar balik RM.
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