FORM-SOP-00BS-MEGS-2018-001

EXPENSE REPORT
PT Mitra Energi Gas Sumatera
NAME : YOKO SASANO JAYA WARDHANA CURRENCY : Rp. Prepared Date : 2/7/2019
EMPLOYEE NUMBER : 20130405 OTHER CURRENCY: WBS to be Charged :
DEPARTMENT : OPERATIONS EXCHANGE RATE : Cost Center to be Charged : A502A00100 Management
TITLE : HSE OFFICER
Type of Expenses :
TRAVELING COST ENTERTAIMENT COST TOTAL
DAILY ALLOWANCE
DATE ENTERTAIMENT & BUSINESS MEALS & IN OTHER
CITY COUNTRY TIP, LAUNDRY, IN IDR
TRANSPORT ACCOMODATION MEALS GIFT OTHER EXPENSES CURRENCY
PHONE, ETC
08 Jan - 12 Jan 2019 200,000 1,000,000
09 Januari 2019 437,000 437,000
10 Januari 2019 393,009 393,009

TOTAL EXPENSES 1,830,009

PURPOSE OF TRAVEL: ADVANCE
IN OTHER
Date Remark IN IDR CURRENCY
1. Meeting coordination HSE with all MEI asset at Hotel Century Jakarta
2. Meeting coordination and prepared data with Mr. Tomyones (HSE Corporate MEI) about HSE Management Meeting 2018

TOTAL ADVANCES
Receipt Attach : Yes No | explain: Amount in words:
Submitted by Review & Approved by Reviewed by (Business Support) BALANCE TO EMPLOYEE BALANCE TO COMPANY
Make deposit to: Transfer to Company Bank Acc.
Account Name :
Name : Name : Name : Account No :
Date : Date : Date : Bank :
 FORM-SOP-004-BS-MEGS-2018-002
DAFTAR NOMINATIF
TAHUN PAJAK :
PEMBERIAN HIBURAN DAN SEJENISNYA RELASI USAHA YANG DIBERIKAN HIBURAN DAN SEJENISNYA
NO KETERANGAN
TANGGAL TEMPAT ALAMAT JENIS JUMLAH (IDR) NAMA POSISI NAMA PERUSAHAAN JENIS USAHA

Prepared By: Approved by:

Name Name
Sign Sign
 FORM-SOP-004-BS-MEGS-2018-03

BUKTI PENGEMBALIAN KELEBIHAN PEMAKAIAN UANG PERJALANAN DINAS

Nama :
Jabatan :
Nomer Payroll :
Department :
Cost Center :

No Setoran Kelebihan Pemakaian Uang Perjalanan Dinas Mata Uang

IDR
1 Setoran Rupiah (IDR)
2 Setoran Dollar (USD)

Balance Due to Company

................................, ........... 20....

Pegawai

Tanda tangan & Nama Jelas

*) Lampirkan bukti setoran pengembalian uang perjalanan dinas

OP-004-BS-MEGS-2018-03

ANG PERJALANAN DINAS

Mata Uang
USD
 FORM-SOP-004-BS-MEGS-2018-004

FORMULIR PERNYATAAN PENGELUARAN NYATA

(SEBAGAI LAMPIRAN DARI EXPENSE REPORT)

Dengan ini saya menyatakan;

Nama :
Jabatan :
Nomer Payroll :
Department :
Cost Center :

Biaya-biaya yang saya keluarkan pada perjalanan dinas saya ke ................... dalam rangka ...........
tanggal ......... ecara pengeluaran nyata, perinciannya adalah sebagai berikut :

No Jenis Pengeluaran Jumlah Keterangan

1
2

Total

Demikian pernyataan ini dibuat dengan sebenar-benarnya. Apabila pernyataan yang saya sampaikan
tidak benar, saya bersedia menerima sanksi tindakan disiplin sesuai ketentuan yang berlaku di
Perusahaan.

Yang menyatakan, Menyetujui,

Nama : Atasan
Tanggal :

Form ini dipergunakan untuk mengklaim biaya transportasi dimana tagihan tidak dapat diberikan oleh transporter
OP-004-BS-MEGS-2018-004

... dalam rangka ...........

Keterangan

ataan yang saya sampaikan

ntuan yang berlaku di

iberikan oleh transporter

 FORM-SOP-004-BS-MEGS-2018-005

BUSINESS TRAVEL REQUEST FORM

& FIELD ASSIGNMENT LETTER
NAME : YOKO SASANO JAYA WARDHANA

TITLE : HSE OFFICER

DEPARTMENT : HSE

PURPOSE OF TRAVEL : COORDINATION MEETING WITH HSE CORPORATE & PREPARED HSE MANAGEMENT MEETING 2018
NAME OF PROVINCE/COUNTRY : JAKARTA

BUSINESS DATE : 08/01/2019 TO 12/01/2019 TOTAL OF 5 DAYS

DEPARTURE DATE : 08/01/2019 RETURN DATE 12/01/2019 TOTAL OF 5 DAYS

ESTIMATED EXPENSES ARE AS FOLLOWS:

EXCHANGE RATE BUDGETED Amount PAID IN

Expenses ADVANCES Non ADVANCES
USD RP. USD RP. USD RP.
AIR TICKET / TRAIN
AIRPORT TAX/FEE
PERDIEM ( 5 DAY (S) @Rp, 200.000,- ) Rp 1,000,000
SEMI PERDIEM ( ... DAY (S) @ USD ………... /Rp………...)
HOTEL CHARGES ( 2 NIGHT(S) @Rp. ) Rp 1,000,000
GROUND TRANSPORTATION (INCL.Car Rental, Petrol, Taxi, Boat)
REPRESENTATION
COURSE FEE
OTHERS (to specify)

TOTAL $ - Rp 2,000,000 $ - -

PASSAGE REQUEST
PASSPORT / VISA
AIR TICKET BUSINESS ECONOMY X
TRANSPORTATION
OTHERS

EMPLOYEE BUSINES SUPPORT MANAGER DIRECTOR

(DOMESTIC) (OVERSEAS)

NAME :
DATE : DATE : DATE : DATE :

PLEASE ATTACHED THIS FORM WITH PAYMENT REQUEST AND EXPENSES REPORT
ADVANCE REQUEST MUST BE RECEIVED BY BUSINESS SUPPORT 3 (THREE) DAYS PRIOR TO TRAVEL
PAYMENT IS MADE VIA BANK TRANSFER
 PAYMENT REQUEST FORM-SOP-004-BS-MEGS-2018-006

Please make payment in the sum of:

Currency : Rp US$ Sing$ Yen
Base : Rp. 1830009 Amount in Words
V.A.T : Rp. # SATU JUTA DELAPAN RATUS TIGA PULUH RIBU SEMBILAN
Total : Rp. 1830009 RUPIAH #
W/H Tax : Rp.
To be Paid : Rp. 1830009
For Vendor Employee Advance Medical WBS to be Charged: Cost Center to be Charged:
A502A00100 Management
Department: MANAGEMENT (BOD)
Remmitance Mode: Bank Account Information
Cheque Giro Transfer Cash Account Name : YOKO SASANO JAYA WARDHANA
Account Number : 9000011743276
Bank : MANDIRI
Description BUSINESS TRAVEL FOR COORDINATION MEETING WITH HSE CORPORATE & PREPARED HSE MANAGEMENT MEETING
2018

Requested by Reviewed by Verified by Approved by

Date: Date: Date: Date:

CHECK LIST DOCUMENT CHECKED BY
Date Received :
Due Date : Ref Initial
Original Invoice Received Date :
Receipt/Kuitansi Posting Date :
Purchase Order Due Date :
Contract/Agreement Parked Doc. No. :
Delivery Order 1 A/P Fi. Doc. No.
st
:
Passage Request Payment Fi. Doc. No. :
Guarantee Letter Reversal Fi. Doc. No. :
Others 2nd A/P Fi. Doc. No. :
Batch No. :
 FORM-SOP-004-BS-MEGS-2018-007

FLOWCHART BUSINESS TRAVEL

OP-004-BS-MEGS-2018-007