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Muazzin AV Retail Services Sdn. Bhd. (1265200-U)
No.15A (1st Floor), Jalan 3/69, Seksyen 3,
43650 Bandar Baru Bangi, Selangor
No Tel : 03-87334708
http://www.pasystemmasjid.com
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Muazzin AV Retail & Services Sdn. Bhd. (1265200-U)
No.15A (1st Floor), Jalan 3/69, Seksyen 3,
43650 Bandar Baru Bangi, Selangor
No Tel : 03-87334708
http://www.alunanfirdausi.com
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BENEFITS CLAIM FORM
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Employee's Name
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Employee's ID
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Department
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Date of Confirmed
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Date of Application
:
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Type of Benefits
(please tick)		DescriptionBalance Before ApplyTotal Claim (RM)
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Medical Claim
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Courses/seminar Claim
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Glasses Claim
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Transportation Claim
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Takaful Claim
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Taska/tadika claim
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Others
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Total
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Applied by:
Verified by:
Approved / Disapproved by :
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Applicant's signature
Verified by:
Director's signature
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Date:Date:Date:
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Please take note:
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1. All benefits claim shall be submitted to Head of HR & Admin for approval accompanied by supporting
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docurments (receipts).
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2. All benefit claim must be made upon confirmation until end of the year only and cannot be carry forward.
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 All claim before confirmation date are not accepted
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3. For Glasses claim only can be apply after 1 years after confirmation date
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For office use
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Employee's name :
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Date of application :
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Claim Balance :
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MedicalTakafulGlassesCourses/seminar
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