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GENERAL FORM NO. 2 GENERAL FORM NO.

2
Revised January 1992 Revised January 1992

REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT

Date No. Date No.

RECEIVED from RECEIVED from


(Name) (Name)

the amount the amount


(Official Designation) (Official Designation)

of (P ) of (P )
(In Words) (In Figures) (In Words) (In Figures)

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

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