GENERAL FORM NO.

2 Revised January 1992 REIMBURSEMENT EXPENSE RECEIPT

Date RECEIVED from
(Name)

GENERAL FORM NO. 2 Revised January 1992 REIMBURSEMENT EXPENSE RECEIPT

Date RECEIVED from
(Name)

No.

No.

the amount
(Official Designation) (Official Designation)

the amount of
(In Words)

of
(In Words)

(P
(In Figures)

(P
(In Figures)

to payment for
(Payments for subsistence, services, rentals or transportation should show inclusive dates, purpose, distance, inclusive places of travel, etc.)

to payment for
(Payments for subsistence, services, rentals or transportation should show inclusive dates, purpose, distance, inclusive places of travel, etc.)

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

PAYEE

WITNESS