EMPLOYEE EXPENSE REPORT

Cut-off date for submission to Finance: 10th of each month. Division : Manufacturing Operation Mileage Disclosure:
Employee No : EFB 000129 Finish : mi

Employee Name : Jamesdin Situmorang Department : HSE EST. Personal : mi

Period : 05 Nov - 04 Dec 2016 Exchange Rate: EST. Business : mi

Exchange Rate Basis : (GSI Corp. Rate / Staff Rate (Money Changer/Credit Card Bill / Internet /
Please tick the appropriate box:: Newspaper, / if Others (please specify)
Local Expenses1 Overseas Trip Expense2 Relocation Expense Report
PURPOSE OF EXPENSES
Internet/ Material Project Account Exchange Attachment
Total Amount
Date Overtime Meals Transport Entertainment Seafare Tel. Calls s Others No. No. Total (Foreign Currency) Rate (Receipt) Indicate points of origin/destination & nature of business conducted
(IDR)
(A) (B) (C) (D) (E) (F) (G) Name, position & company of persons entertained and specific biz discussion
5-Nov-16 135,000 135000 Ticket two way ( Karimun - Batam) - (Batam - Karimun)

6-Nov-16

7-Nov-16

8-Nov-16

9-Nov-16

10-Nov-16

11-Nov-16 135,000 135000 Ticket two way ( Karimun - Batam) - (Batam - Karimun)

12-Nov-16

13-Nov-16

14-Nov-16

15-Nov-16

16-Nov-16

17-Nov-16

18-Nov-16 85,000 85,000 One way Ticket ( Karimun - Batam)

19-Nov-16

20-Nov-16 85,000 85,000 One way Ticket ( Batam - Karimun)

21-Nov-16

22-Nov-16

23-Nov-16

24-Nov-16

25-Nov-16 135,000 135,000 Ticket two way ( Karimun - Batam) - (Batam - Karimun)

26-Nov-16

27-Nov-16

28-Nov-16

29-Nov-16

30-Nov-16

1-Dec-16

2-Dec-16

3-Dec-16 85,000 85,000 Ticket one way ( Karimun - Batam)

4-Dec-16 85,000 85,000 Ticket one way ( Batam - Kartimun)

Total: 0 745,000 0 0 0 745,000 Total 745,000 IDR : 745,000.00

Employee Certification : Date: Total Advance :
Approval : Date: Balance Due Employee :
Approval : Date: Balance Due Company : 745,000.00

Notes: 1. Local Expenses - Expense Claims for local expenses like taxi, petrol, parking, dental, meals etc, shall be submitted in ONE Expense Report each month.
2. Overseas Trip Expense - Expense Claim for Oversees trips shall be submitted on a PER TRIP basis. Wherever applicable, indicate the Project Number(s).
3. Exchange Rates Applied for Foreign Currency Expense: a) Exchange rates shall be based on money change rate (with receipts attached).
b) Where money changer rates not available, Finance will use GSI corporate rate for the month of the overseas trip.
c) Where employee Credit Card exchange rate is significantly different from that calculated by Finance in (b) above, the differential may be claimed
in a subsequent expense report with Credit Card statement of accounts attached.

Requested By, Prepared By, Verified By, Authorised By, Approved By,

Jamesdin Situmorang Elisabet Riya Ivy Tai Karim Tanado