TRAVEL SUB by umn15763

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									                                               MPUMALANGA PROVINCE
                                                      BAS PAYMENT ADVICE
                               Claim No.:                                                            Department:
                               Captured by:
                               Date Captured:                                                        Office From:
                               Authorised by:
                               Authorise by:
CLAIM DESC.

CLAIMED BY
Initials
Surname / supplier
Address
                                                                                                                Postal code
Source doc. Tye                           Source document details                                            Template type details
       Receipt voucher      purchase order No.:                                     Settlement details.:
       Invoice                                                                      Settlement date:
       Sundry               source doc. No.:                                        Discount %
                            Source doc. Date:             2            0            Discount date                    /               /   2     0
PAYMENT METHOD                             CHEQUE DETAILS                                                      BANK DETAILS
       System Cheque                                                                Bank Acc. No.:
       Manual Cheque        Cheque No.:                                             Branch Code:
       EBT                                                                          Bank Acc. No.:
                            Cheque Date:                                            ie: Current, Savings, Transmission, etc.
                                                (dd/mm/yyyy)


                                                                                          DB Date:                                                 dd/mm/yyyy
Allocation
    Segment Type                                                                     Segment Detail
Fund
Responsibility
Objective
Item
Matching Field 1
Matching Field 2
                                                               Allocation Amount:           R                                                             -
                                                                                            Allocation Percentage                                         1     0   0
Allocation
    Segment Type                                                                     Segment Detail
Fund
Responsibility
Objective
Item
Matching Field 1
Matching Field 2
                                                               Allocation Amount:           R                                                             -
                                                                                            Allocation Percentage                                         1     0   0
Total Amount Paid :

                         Logis section                                                                   Finance section




         Compiled by           Print           Signature           Date               Compiled by    Print             Signature             Date




         Compiled by           Print           Signature           Date               compiled by    Print             Signature             Date
                                    DETAILED CLAIM INFORMATION
                                     Date   Date   Time   Time        Number
             Description             From    To    From    To     Days     Hours
                                                                                    Rate   Amount


Middelburg-Marbel Hall-Middelburg
Middelburg-Lydenburg-Middelburg

Middelburg-Witbank-Middelburg

Middelburg-Wolwekrans-Middelburg
Middelburg-Witbank-Middelburg

Middelburg-Lydenburg-Middelburg

Middelburg-Wolwekrans-Middelburg




                                                                 Tot Amount of Claim :
                                                          Less Tot Amount of Advance :
                                                                 Nett Amount of Claim :
G.P.KEMP
              13014421
Advance No.:                                                                                                        Claim No.:
                                                          Captured by:
                                                          Date Captured:
                                                          Authorised by:
                                                          Authorise by:
CLAIMED BY
SURNAME & INITIALS                                        M                    T                  S         W       E                N
PERSAL NO.:                                                                1                  2         9       7                5             2


CLAIM DESC.
PERIOD FROM:
                                    (dd/mm/yyyy)                                                                                         (dd/mm/yyyy)


REFERENCE NO.:

PAYMENT METHOD                                                                                                                   CHEQUE DETAILS
       System Cheque
       Manual Cheque                   Cheque No.:
       EBT
                                       Cheque Date:
                                                                (dd/mm/yyyy)




Allocation
Segment Type
Fund               C                   U                  R                    R                  E         N       T
Responsibility D                       I                  V                    :                  N         H                        R
Objective          M                   A                  I                    N                  :         S       T                R
Item               S                   U                  B                    S                  I         S       T                A
Matching Field 1
Matching Field 2
                                                                                   Allocation Amount:



Allocation
Segment Type
Fund
Responsibility
Objective
Item
Matching Field 1
Matching Field 2
                                                                                   Allocation Amount:



Total Amount Paid :                    R


I certify that I was actually and necessarily employed travelling or detained on public service

during the period(s) stated above, that the charges are in accordance with the authorised
rate and that the incidental expenses have been actually and necessarily disbursed.




                          SIGNATURE OF APPLICANT                                      RANK

                                     PRINT NAME
                                                             MPUMALANGA PROVINCE
                                                         BAS TRAVEL AND SUBSISTENCE CLAIM




             I                  S                J
                    4       9



                                    PERIOD TO:
     (dd/mm/yyyy)




CHEQUE DETAILS
                                                             Bank Acc. No.:
                                                             Branch Code:
                                                             Bank Acc. No.:
                                                             ie: Current, Savings, Transmission, etc.



                                                                   DB Date:


                                                                                        Segment Detail
             E          X       P   E            N   D       I              T            U
             E          G           P            W           D              I            S
             U          C       /   B            U   I       L              D            I
             N          C       E   :            D   O       M              E            S



                                                                                                  R
                                                                                             Allocation Percentage



                                                                                        Segment Detail




                                                                                                  R
                                                                                             Allocation Percentage
ANNUAL SALARY   DATE

  R27714.00
GA PROVINCE
SUBSISTENCE CLAIM
                           Match No.:


                           Office From:
                           SDR No.:
                                        (If applicable)




                                                                              BANK DETAILS
                                                              9       0          4           1       0       6
                                                              6       3          2           0       0       5
                                                          S       A       V          I           N       G
smission, etc.




 Segment Detail
                 R         E
                 T         R              I               C       T
                 N         G                              N       H
                 T         I              C




   Allocation Percentage



 Segment Detail




   Allocation Percentage
       CERTIFIED CORRECT
DATE   DATE   /   /


                               PRINT NAME
                      page 2
    0   3                6   7


S




            dd/mm/yyyy




                                 -
                                     1   0   0




                                 -
                                     1   0   0
                APPROVED
DATE   /   /


               PRINT NAME

								
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