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GAAM Vol.

II

Appendix 8

Revised January 1992

__________REIMBURSEMENT EXPENSE RECEIPT __________

GAAM Vol. II

Appendix 8

Revised January 1992

__________REIMBURSEMENT EXPENSE RECEIPT __________

_________________________________________________________________________
DATE______________________________No.____________________________________

_________________________________________________________________________
DATE______________________________No.____________________________________

RECEIVED from _______________________________________________________


(Name)
________________________________________________________
in the amount
(Official Designation)
of _______________________________________________________ (P ___________)
(In words)
(In Figures)
In payment for ____________________________________________________________
(Payments for subsistence, services
_________________________________________________________________________
rental of transportation should show inclusive dates

RECEIVED from _______________________________________________________


(Name)
________________________________________________________
in the amount
(Official Designation)
of _______________________________________________________ (P ___________)
(In words)
(In Figures)
In payment for ____________________________________________________________
(Payments for subsistence, services
_________________________________________________________________________
rental of transportation should show inclusive dates

_________________________________________________________________________
purpose, distance, inclusive points of travel, etc.)

_________________________________________________________________________
purpose, distance, inclusive points of travel, etc.)

_________________________________________________________________________
_________________________________ PAYEE _________________________________

_________________________________________________________________________
_________________________________ PAYEE _________________________________

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
_____________________________________________________
_________________________________________________________________________

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

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