G.P.S.

81/115222
ANNEXURE B 81/115222

Z43
EIS TEN OPSIGTE VAN REISE MET PRIVATE MOTORVERVOER OP AMPTELIKE DIENS
CLAIM IN RESPECT OF OFFICIAL JOURNEYS UNDERTAKEN BY PRIVATELY OWNED MOTOR TRANSPORT
Geëis deur (in blokletters) Claimed by (in Departement van
blockletters) RICHARD WHITMORE Department of FAMILY MEDICINE/
EMERGENCY MEDICINE
RangRank INTERN

Adres (Waarheen skatkisorder gestuur moet word) Address (To which Maand
warrant voucher must be sent) __________________________________________ Month SEPTEMBER 2020

vir Rekenmeester/for Accountant

G10 THE BREAKWATER APARTMENTS VA WATERFRONT CAPE TOWN 8001

Hoofkwartier/Headquarters Eis/Claim no.

BESKRYWING VAN VOERTUIG - DESCRIPTION OF VEHICLE

Fabrikaat en model Jaar van vervaardiging Year Tipe (motorkar, motorfiets, bromponie,ens) Registrasienommer Enjinslag, volumegroep in
Make and model of manufacture Type (Motorcar, motorcycle, scooter,etc.) Registration number cm³
Engine swept volume group
in cm³

POLO COMFORTLINE 1.0 2018 MOTORCAR 1.0L

OPSOMMING VAN REISE AFGELê EN EIS OM TOELAES

SUMMARY OF JOURNEYS UNDERTAKEN AND CLAIM FOR ALLOWANCES
(Vir besonderhede sien anderkant - For details see reverse)
Vir Rekenmeester For
Accountant

Kilometer gereis Tarief per kilometer Bedrag Toewysing Allocation

Kilometres travelled Kol. Tariff per kilometre
Amount
9 - Col.9
R C
Kilometertoelae
Kilometre allowance

*Passasierstoelae
Passenger allowance

*Stalling van parkering Garaging

and parking

*Nie van toepassing op motorfietse en bromponies nie Not Totaal

applicable in the case of motorcycles and scooters Total

Ek sertifseer dat dit vir my nodig was om ampshalwe diè reise te onderneem ten opsigte waarvan ek 'n eis indien en dat die toelaes wat ek eis in ooreenstemming is met
die gemagtige tariewe ten opsigte van my motorkar/motorfiets/bromponie en dat die passasiers werklik en noodsaaklik op amptelike diens vervoer is.
I certify that I was required to perform the travelling claimed for on official duty and that the allowances claimed are in accordance with the rates authorised in respect of
my motorcar/motorcylcle/scooter and that the passengers were actually and necessarily conveyed on official business

Handtekening van eiser Datum 16/10/2020

Signature of claimant Date

KORREK VERKLAAR • CERTIFIED CORRECT GOEDGEKEUR • APPROVED

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……………………………………………………………..……………. …………...……………………………………………………………………………
Hoof van Afdeling/Kantoor - Head of Branch/Office Departementshoof - Head of Department

Datum • Date Datum • Date

Ontvang van die rekenpligte amptenaar die bedrag van Received
from the accounting officer the amount of

Betaal per s/o no.

…………………..Rand…………………………………….sent/cent Paid by W.V. no. …………………………………………..

…………………………………………… ……………………………. Datum

Handtekening • Signature Datum • Date Date ……………………………………………

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 81/115222

Z43

ORT

EDICINE/

20

ountant

volumegroep in

ept volume group

For

Kode
Code

nstemming is met

sed in respect of

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……………..

………………

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 81/11
(
BESONDERHEDE VAN REIS (VAN PLEK TO PLEK)* Kilometerafstand
DETAILS OF JOURNEY (POINT TO POINT)* Kilometre distance
1 2 3 4 5 6 7 8 9 10
Datum Rede Reason Vertrek van Tyd Aangekom Tyd Kilometerstand by Kilometerstand op Kilometerafstand Kilometerafstand deur
Date Departed Time by Time aanvang van reis elk plek onder tussen elke amptelike passier(s)
from Arrived Speedometre kolom 5 vermeld en opeenvolgende afgelê Kilometre
at reading at na afloop van reis plek vermeld in distance travelled by
commencement of Speedometre kolomme 3 en 5 en official passenger(s)
journey reading at each na afloop van reis
point mentioned in Kilometre distance
column 5 and at the between each
end of the journey consecutive point
mentioned in
columns 3 and 5
and at end of
journey

1/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 32440 32552 112

2/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 32552 32664 112

3/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 32664 32776 112

4/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 32776 32888 112

7/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 33081 33193 112

8/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 33193 33305 112

9/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 33305 33417 112

10/9/2020 WORK WESFLEUR HSOPITAL 16.00 VA WATERFRONT 16.45 33417 33529 112

11/9/2020 WORK VA WATERFRONT 07.30 WESFLEUR 08:10 33529 33585 56

12/9/2020 WORK WESFLEUR HSOPITAL 08.30 VA WATERFRONT 09:30 33585 33641 56

14/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 33715 33827 112

15/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 33827 33939 112

Let Wel - *Plek beteken die plek waar die reis begin en eindig asook alle plekke onderweg waar die reis om amptelike of private redes onderbreek word

Note - * Point means the place where the official journey is commenced and terminated and all places en route where the journey is broken whether for official or private reasons

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16/9/2020 WORK VA WATERFRONT 07.30 WESFLEUR 08:10 33939 33995 56

17/9/2020 WORK WESFLEUR HSOPITAL 08.30 VA WATERFRONT 09:30 33995 34051 56

18/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 34051 34163 112

21/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 34163 34275 112

22/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 32475 34387 112

23/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 34387 34499 112

24/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 34499 34611 112

25/9/2020 WORK VA WATERFRONT 07.30 VA WATERFRONT 16:45 34611 34723 112

28/9/2020 WORK WESFLEUR HSOPITAL 16.00 VA WATERFRONT 16.45 34723 34835 112

29/9/2020 WORK VA WATERFRONT 07.30 WESFLEUR 08:10 34835 34891 56

30/9/2020 WORK WESFLEUR HSOPITAL 08.30 VA WATERFRONT 09:30 34891 34947 56

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(Z43)
Passasiers
Passengers
11
Naam, rang en
departement
Name, rank and
department

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

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R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

R Whitmore Intern Family Med

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