You are on page 1of 1

Gen. Form No. 2 Revised January 1992 Gen. Form No.

2 Revised January 1992


REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date No. Date No.

RECEIVED from __________________________________________ RECEIVED from __________________________________________


(Name) (Name)

_____________________________________________ the amount of _____________________________________________ the amount of


(Official Designation) (Official Designation)

__________________________________________ (P___________ ) __________________________________________ (P___________ )


(In Words) (In Figures) (In Words) (In Figures)

in payment for ____________________________________________ in payment for ____________________________________________


(Payments for subsistence, services, (Payments for subsistence, services,

________________________________________________________ ________________________________________________________
rental or transportation should show inclusive dates. rental or transportation should show inclusive dates.

________________________________________________________ ________________________________________________________
purposes, distance, inclusive points of travel, etc.) purposes, distance, inclusive points 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______________________________________________

Gen. Form No. 2 Revised January 1992 Gen. Form No. 2 Revised January 1992
REIMBURSEMENT EXPENSE RECEIPT REIMBURSEMENT EXPENSE RECEIPT
Date No. Date No.

RECEIVED from __________________________________________ RECEIVED from __________________________________________


(Name) (Name)

_____________________________________________ the amount of _____________________________________________ the amount of


(Official Designation) (Official Designation)

__________________________________________ (P___________ ) __________________________________________ (P___________ )


(In Words) (In Figures) (In Words) (In Figures)

in payment for ____________________________________________ in payment for ____________________________________________


(Payments for subsistence, services, (Payments for subsistence, services,

________________________________________________________ ________________________________________________________
rental or transportation should show inclusive dates. rental or transportation should show inclusive dates.

________________________________________________________ ________________________________________________________
purposes, distance, inclusive points of travel, etc.) purposes, distance, inclusive points 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______________________________________________

You might also like