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PT.

EVERGOOD PLASTIC PACKAGING INDONESIA


Jalan Gajahmada No.8, RT 015 RW 006, Desa Kedungturi, Kecamatan Taman, Kabupaten Sidoarjo, Jawa Timur, Indonesia

DOCUMENT TITLE: CASH ADVANCE APPLICATION FORM

Date of Application:

Applicant Name: Position: Department:

Requested Amount: IDR (in words):

Years of Service:

Purpose of Cash Advance:

Educational Fees Fire and Natural Calamities Hospitalization Fees

House Improvement/Repair/Transfer Victim of Malicious Acts, Crime or Robbery Death of a Family Member

Special Occasion:

Employee Signature over Printed Name

This portion is for HRD use and confirmation:

Employee Years of Service:

No. of Months for


C.A Amount Monthly Deduction Start of Deduction End of Deduction
deduction

Rp. Rp.

Attachments:
Request Letter Others

Certified by:
HR Staff

Noted by: Ms. Gina Opsimar Approved by: Ms. Iliana Tan
General Manager Managing Director

Confidentiality Notice:
All information and documents attached to the Cash Advance Application Form shall only be used for the processing of this application and must be kept confidential.
PT EVERGOOD PLASTIC PACKAGING INDONESIA
Jalan Gajahmada No.8, RT 015 RW 006, Desa Kedungturi, Kecamatan Taman,
Control #: DEL2024 -
Kabupaten Sidoarjo, Jawa Timur, Indonesia

DRIVER'S DAILY DELIVERY LOG SHEET

Name of Driver: Fuel Purchase Record

Vehicle Description: Kilometer Reading: Unit Price: Rp. Date:

Vehicle Plate No.: No. of Litres: Total Amount: Rp.

Origin Destination Return Trip Trip Expenses


Trip Deliver To / Pick-up From Time of Time of Unloading Time of Time of
Kilometer Reading Kilometer Reading Toll Fee Loading Fee Traffic Fee Other Expenses
Departure Arrival Start Time End Time Departure Arrival

1 km : : : : : : km Rp. Rp. Rp. Rp.

2 km : : : : : : km Rp. Rp. Rp. Rp.

3 km : : : : : : km Rp. Rp. Rp. Rp.

4 km : : : : : : km Rp. Rp. Rp. Rp.

5 km : : : : : : km Rp. Rp. Rp. Rp.

6 km : : : : : : km Rp. Rp. Rp. Rp.

7 km : : : : : : km Rp. Rp. Rp. Rp.

8 km : : : : : : km Rp. Rp. Rp. Rp.

9 km : : : : : : km Rp. Rp. Rp. Rp.

10 km : : : : : : km Rp. Rp. Rp. Rp.

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