GENERAL FORM NO.

02
REVISED JANUARY 1998

GENERAL FORM NO. 02

REVISED JANUARY 1998

REIMBURSEMENT EXPENSE RECEIPT

_________________________________________________________

REIMBURSEMENT EXPENSE RECEIPT

_____________________________________________________________

Date
No.
___________________________________________________________________

Date
No.
________________________________________________________________________

RECEIVED from__________________________________
(Name)
_______________________________________________________ in the amount
(Official Designation)
_________________________________________________(P ________________)
(In words)
in payment for ______________________________________________________
(Payments for subsistence, services, rental,
___________________________________________________________________
or transportation should show inclusive dates, purpose, distance,
___________________________________________________________________
inclusive
points
of
travel
etc.)

RECEIVED from ______________________________________

(Name)
___________________________________________________________ in the amount
(Official Designation)
___________________________________________________ (P _________________)
(In words)
in payment for ___________________________________________________________
(Payments for subsistence, services, rental,
________________________________________________________________________
or transportation should show inclusive dates, purpose, distance,
________________________________________________________________________
inclusive
points
of
travel
etc.)

PAYEE
Name/Signature _____________________________________________________
Address ____________________________________________________________
Comm. Tax Cert. No. _________________________________________________
Date of Issue ________________________________________________________
Place of Issue ________________________________________________________
WITNESS
Name/Signature _____________________________________________________
Address ____________________________________________________________
Comm. Tax Cert. No. _________________________________________________
Date of Issue ________________________________________________________
Place of Issue ________________________________________________________

PAYEE
Name/Signature __________________________________________________________
Address ________________________________________________________________
Comm. Tax Cert. No. _____________________________________________________
Date of Issue ____________________________________________________________
Place of Issue ____________________________________________________________
WITNESS
Name/Signature __________________________________________________________
Address ________________________________________________________________
Comm. Tax Cert. No. ______________________________________________________
Date of Issue ____________________________________________________________
Place of Issue ____________________________________________________________