7/21/2019 Dsoc Sept 2015

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The detail sheet of claim

Project Name IPTV TELKOMPO NO.Subcontractor Name CAD Solusindo

Muh. Khairul Akbar / 6469 4!"S#$%#&b#r'( )!

Long-distance transportation expense

NO. DAT T!"P # $"%L %&!! N%' A(O&NT

TOTAL -

"ntra-cit) transportation expenseNO. DAT T!"P # $"%L %&!! N%' A(O&NT

TOTAL -

accommodation expenseNO DAT - chec* in time DAT - chec* out time Nation or District P!"% %&!! N%'

TOTAL

+isa expenseNO expenditure date %&!! N%' A(O&NT remar*

TOTAL -

communication expenseNO expenditure date %&!! N%' A(O&NT remar*

1 28-Sep-15 IDR 200,000

TOTAL ,

other expenseNO expenditure date %&!! N%' A(O&NT description

TOTAL

TOTAL A(O&NT ALL /P NS S , .

Signed by,

*a&# o+ E&$lo,## T#a& L#ad#r Project Manager Muh. Khairul Akbar Muh Hapi al Kha!!ab Wang Hong Kun

*o%# -a $l#as# $ro id# %h# r#la%i # su$$or%in 0h#n sub&i% %h# r#i&burs#&#n%b $l#as# indi1a%# onl , on# $#rson2s #3$#ns# on #a1h sh##% as $ossibl#

1 #i&burs#&#n%2s $#riods- on1# 1lai& #a1h &on%h5 and should b# sub&i% &a3i&al in ( &on%hsd Do no% 1o&bin# a rou$ o+ ou1h#rs in%o a su& on#5 $l#as# ll in %h# blank 0i%h #a1h ou1h#r

%laimed b)Periods of claim

7/21/2019 Dsoc Sept 2015

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remar*

remar*

A(O&NT remar*

-

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