Update February 2012

CLAIM FORM FOR PART TIME: TUTOR / GRADER / DEMONSTRATOR

KULLIYYAH OF ENGINEERING

INTERNATIONAL ISLAMIC UNIVERSITI MALAYSIA

MONTH: ___________20___

NAME : ____________________________________________________________________________

HOME ADDRESS : ____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

TEL NO : __________________________________ I/C /PASSPORT NO : ____________________

INCOME TAX NO : __________________________________ *EPF NO : ____________________

BANK ACCOUNT NO :__________________________________ BMMB [ ] BIMB [ ] (Bank Muamalat or Bank Islam only)

OTHERS : RESEARCH ASST. (RA) [ ] MONTHLY PAY : RM _________

: PARTIAL SCHOLAR [ ]

: FULL SCHOLAR [ ]

*NOTE: EPF Number is compulsory for Malaysian citizen

REQUESTED BY APPROVED BY

I HERE BY CERTIFY THAT THE ABOVE CLAIM ARE TRUE

HEAD OF DEPARTMENT

SIGNATURE __________________________

SIGNATURE ______________________

NAME ___________________________

NAME ______________________

OFFICIAL STAMP

Rules and Regulation:

1. COMPULSORY: All claims form must be written with pen (blue / black) only.

2. COMPULSORY: All claims form must be attached with VALID OFFER LETTER.

3. A completed claim form should be submitted 1st day of the following month to the FINANCE UNIT OF KOE.

4. Any rejected claim will be under responsibility of Personal assistant (P.A) to inform the applicant.

5. Payment for claims (with EPF number) will be made on 15th

and claim (without EPF number) will be made on last day of the month.

6. All students are only eligible to apply for a maximum of 3 SECTIONS ONLY.

7. Claims for all sections (3 sections only) should be made in ONE FORM ONLY.

*TOTAL

POSITION COURSE CODE AND TITLE SECT RM LECTURER

SIGNATURE

LECTURER NAME

/ STAMP

TOTAL

Update February 2012

KULLIYYAH OF ENGINEERING

INTERNATIONAL ISLAMIC UNIVERSITY MALAYSIA

PART TIME: LECTURER / TUTOR / DEMONSTRATOR

(COMPULSORY: Kindly Attach the Offer Letter)

MONTH: _____________ 20__

NAME ____________________________________________________________________

HOME ADDRESS ____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

TEL. NO. (RES) ____________________________________________________________________

I/C or PASSPORT NO. ____________________________________________________________________

INCOMETAX NO. _________________________ *EPF NO. ______________________

*NOTE : Claim Above RM5 / Hour – *EPF Number is Compulsory for Malaysian Citizen

BANK ACCOUNT NO. ________________________________________ BMMB BIMB

(Bank Muamalat or Bank Islam only)

PENALTY RM 50.00 will be charged if FALSE BANK ACCOUNT NO. given

SUBJECT ________________________________________ RATE PER / HR :

A. TOTAL HOURS

DATE TIME TOTAL HOURS MILEAGE

RM HOURS TO & FROM

TOTAL

**Total Staff No.

Update February 2012

MILEAGE

FROM ___________________________ TO ____________________________________

TOTAL ( KM ) ______________________________________________________ ( TO & FROM )

TYPE OF CAR ________________________________ CC ______________________________

Kilometer Cents Per Kilometer Total

Amount Car Cc > 1500 Car Cc > 1300 Car Cc < 1300

First 500 55 41 35

150 after 500 51 37 31

150 after 650 48 35 29

150 after 800 39 33 29

150 after 950 38 32 27

150 after 1100 36 32 27

150 after 1250 35 32 27

150 after 1400 33 31 26

150 after 1550 33 31 26

For every km after 1700 32 30 24

Total

I HEREBY CERTIFY THAT THE ABOVE CLAIMS ARE TRUE

SIGNATURE __________________________________

NAME __________________________________

RECOMMENDED BY ( LECTURER OF THE COURSES )

SIGNATURE __________________________________

NAME __________________________________

( OFFICIAL STAMP )

APPROVED BY

HEAD OF DEPARTMENT

SIGNATURE __________________________________

NAME __________________________________

( OFFICIAL STAMP )

Rules and Regulation:

1. COMPULSORY: All claims form must be written with pen (blue / black) only.

2. COMPULSORY: All claims form must be attached with VALID OFFER LETTER.

3. A completed claim form should be submitted 1st day of the following month to the FINANCE UNIT OF KOE.

4. Any rejected claim will be under responsibility of Personal assistant (P.A) to inform the applicant.

5. Payment for claims (with EPF number) will be made on 15th

and claim (without EPF number) will be made on last day of the month.