GENERAL FORM NO.

2
Revised January 1992

GENERAL FORM NO. 2

Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT

Date

REIMBURSEMENT EXPENSE RECEIPT

No.

Date

RECEIVED from

No.

RECEIVED from
(Name)

(Name)

the amount

the amount

(Official Designation)

of

(Official Designation)

(P
(In Words)

of

(P

(In Figures)

to payment for

(In Words)

(In Figures)

to payment for
(Payments for subsistence, services,

(Payments for subsistence, services,

rentals or transportation should show inclusive dates,

rentals or transportation should show inclusive dates,

purpose, distance, inclusive places of travel, etc.)

purpose, distance, inclusive places of travel, etc.)

PAYEE

PAYEE

Name/Signature
Address
Residence Cert. No.
Date of Issue
Place of Issue

Name/Signature
Address
Residence Cert. No.
Date of Issue
Place of Issue
WITNESS

Name/Signature
Address
Residence Cert. No.
Date of Issue
Place of Issue

WITNESS
Name/Signature
Address
Residence Cert. No.
Date of Issue
Place of Issue