Anda di halaman 1dari 1

CRS3

CLAIM FORM FOR OTHER REIMBURSEMENT


(NACCS / TELEPHONE / HANDPHONE / MOTOR VEHICLE / SPECTACLES / GST WAIVER)

Important :-

1) All claims must be submitted to HRS Department within 3 calendar months from the month the expenses were
incurred. (e.g. Expenses paid in January must be submitted to HRS Dept on or before March 31).
2) Only photocopies of telephone bill are acceptable. For other claims, it must be supported with original receipts/bills.
3) Acceptance of claims are subject to existing Collective Agreements and Terms & Conditions of the Bank.
4) Claims must be verified and approved by the appropriate authorities.
5) Separate form to be used for each type of claim.

Note: Bank will not be liable to pay for any interest charged for late payment/settlement of bills by staff to any organization/company.
PARTICULARS OF CLAIMANT
Full Name

ROSLI BIN AHMAD

Staff No

135345

Personal Grade (PG)

R4

Dept/Branch

PEKAN MERU

Cost Centre

MER00

Contact No (Off)

03-33924502

The claims reimbursement amount will be automatically credited into Staff Salary Crediting Account.
NACCS (KLACH / REACH / SPICKS) ALLOWANCE for the month of :
* Day

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

At or before 6 am
Union @ RM35 per day
PG 1-4 @ RM30 per day
After 6am but before 7.30 am
Union @ RM25 per day
PG 1-4 @ RM20 per day
* Tick ( / ) whichever is applicable.

day(s) x
day(s) x

At or before 6.00 am
After 6am but before 7.30 am

RM
RM
TOTAL

= RM
= RM
RM

Note: For NACCS Allowance, do not submit individual forms to HR Services. Tabulate the individual total into Payroll Update Form.
X Telephone / Handphone

Month :

MARCH 12

RM 100

(Delete whichever is not applicable)

Spectacles

First time wearing / Change of lenses (Delete whichever is not applicable)

RM

Motor Vehicle
i) Seasonal Parking
For Tax purposes:
ii) Fuel Home-2400

Month :

(Claimant must be the driver of the vehicle)

RM

Month :

RM

Month :

iii) Fuel Home-Tax


v) Fuel Off-Tax

Month :

iv) Fuel Off-6000

Month :

RM

vi) Maintenance

Month :

RM
RM

Remarks :

Own Car / Pool Car (please provide license plate no) _________________
(Delete whichever is not applicable)

Card No :
GST Waiver for Principal :
Supplementary :
Card No :
Credit Card
Remarks :
Please attached credit card statement

I.C. No.:
I.C. No.:

RM
RM
TOTAL

RM 100

DECLARATION BY CLAIMANT
FOR EXPENSES CHARGED USING CREDIT CARD

I hereby declare the information is true and


correct and if any of the said information is
found to be not true, disciplinary action may
be taken against me.

Credit card No :
RHB Card :
* Non-RHB Card :
Please ( / ) whichever is applicable.

*Justification for using Non RHB Card :


Date : 30/03/2012
VERIFIED BY IMMEDIATE SUPERIOR

Name
Date

:
:

HRS/F0037/V2/2010

APPROVED BY HEAD OF DIV/DEPT/REGIONAL/BRANCH MANAGER

Name
Designation

:
:

Date

Anda mungkin juga menyukai