TRAVEL SUBSISTENCE CLAIM FORM -iso BB Claim.doc
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ZWS ISO 9001:2008 QUALITY MANAGEMENT SYSTEM TRAVELLING AND SUBSISTENCE CLAIM FORM Claimant (Surname and initials) Rugare P Reza EC NUMBER 3436 Section LOSS CONTROL Address: …… ZIMRA BOX 4360 HARARE…………………………………………….. …………………………………………………………….. …………………………………………………………….. ACCOUNT DESCRIPTION ……………………………………………………………….. ……………………………………………………………….. ……………………………………………………………….. ……………………………………………………………….. ……………………………………………………………….. ……………………………………………………………….. EXPENSE CODING $ c CODE FUNCTION LOCATION TOTAL ………………………… Authority to use Private Vehicle Vehicle Registration Numbers Period covered by claim: from: 20/04/2015 to 25/04/2015. SUMMARY OF CLAIM DETAILED OVERLEAF $ 120 C 00 ALLOWANCE FOR THE USE OF OWN VEHICLE …………………...km at …………….per km …………………...km at ……………. per km I CERTIFY THAT:- 1) I was transferred not at my own request 2) This is a true claim for allowances and refunds payable SUBSISTENCE ALLOWANCE ………….. OTHER EXPENSES AND ALLOWANCES e.g. Tollgates……….. Supplementary………. SUBTOTAL …25-00… 25 00 FIN/F. 05 Finance Issue No.1 Version: 1 Issue Date:28/02/15 Page 1 of 4 Cheque No. ……………. DATE STAMP
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Transcript of TRAVEL SUBSISTENCE CLAIM FORM -iso BB Claim.doc
ZIMBABWE REVENUE AUTHORITY
ZWS ISO 9001:2008 QUALITY MANAGEMENT SYSTEMTRAVELLING AND SUBSISTENCE CLAIM FORM
Claimant (Surname and initials)
Rugare P Reza
EC NUMBER 3436Section
LOSS CONTROL
Address: ZIMRA
BOX 4360
HARARE..
..
..
ACCOUNT DESCRIPTION
..
..
..
..
..
..
EXPENSE CODING$c
CODEFUNCTIONLOCATION
TOTAL
Authority to use Private VehicleVehicle Registration NumbersPeriod covered by claim: from: 20/04/2015 to 25/04/2015.
SUMMARY OF CLAIM DETAILED OVERLEAF
$
120C
00
ALLOWANCE FOR THE USE OF OWN VEHICLE
...km at .per km
...km at . per km
I CERTIFY THAT:-
1) I was transferred not at my own request
2) This is a true claim for allowances and refunds payable
to me in terms of the relevant (Travelling and
subsistence) rates currently in use at ZIMRA.
3) Advance to be acquitted within seven(7) days of returning
from a business trip.
27/04/2015. ..
Date Signature of ClaimantSUBSISTENCE ALLOWANCE
..
OTHER EXPENSES AND ALLOWANCES e.g. Tollgates.. Supplementary. SUBTOTAL 25-00 2500
Less: Advance/s Received in respect of this claim
Date Where received Nil Nil
..
TOTAL: Refund/Payable 14500
Certified Correct
..
Head of Office
Checked/Certified not previously paid
For: AccountantPassed for payment
AccountantExamined
Internal Audit External Audit
STATIONED AT Full Day(s)RESIDUAL PART OF DAY OR PROVED MEALS NOT INVOLVING NIGHT DETENTION
OTHER ALLOWANCES e.g. SUPPLEMENTARIESTotal subsistence claimedDISTANCE IN OWN VEHICLEPURPOSE OF JOURNEY
State:
a) Purpose of journey
b) Mode of transport if
other than own
vehicle
c) Class of accommodation, e.g. hotel,
etc, private or field
accommodation/camp
DatePlace from/toTimeBreakfastLunchDinnerAccommoda-
tionTYPE
Bituminous roads including strip roadsOther roadsa) Auditb) ZIMRA
c) HOTEL
Dep.Arr.$ C$ C$ C$ C$ C$ C$ C
20/04/15HARARE-BBRIDGE0830161510-00 10-00
21/04-25/04/15BEITBRIDGE440-0060-00100-00
25/04/15BBRIDGE-HARARE0810155810-00 10-00
TOTALS60-0060-00120-00
Cheque No. .
DATE STAMP
FIN/F. 05 Finance Issue No.1 Version: 1 Issue Date:28/02/15 Page 2 of 2
